Point-of-Service (POS) Plans
A point of service (POS) plan is much like a PPO in the flexibility it affords members. It is also similar to an HMO in that most coverage can be obtained with fairly inexpensive co-pay.
A point-of-service plan can be considered an “open access HMO.” With a point-of-service plan you choose a primary care physician (like HMO) who will provide you with the coverage you need, or will personally refer you to another doctor. The difference is that you can visit a specialist without a referral, but you will pay more than if you see the referred doctor. The exception to this rule is women in need of gynecological care, who have the freedom to refer themselves to another physician with no penalty.
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POS Plan Details
An advantage to the POS plan is that it is less expensive than a PPO, and allows more freedom than an HMO. Although you belong to a network, you are not forced to choose an in-network physician. However, if you choose a doctor out of the network, you may be covering much of the bill. Under a POS plan, you are generally not required to pay a deductible, so that all of your money goes to your medical coverage.
Your out-of-pocket medical costs are usually limited with the POS option, meaning that regardless of the amount of medical coverage you require, there is a set limit to how much you will have to cover out of pocket. For single individuals, this amounts to around $2,400, while families can spend up to $4,000.
People who benefit most from a POS plan are those who need or desire the freedom to choose different doctors for different members of the family. In an HMO, you are required to use a network provider to receive any coverage, while in a POS, you have the option to see any physician you want.
The term Point-of-Service is appropriate for this type of insurance coverage; for each doctor's visit or medical emergency you pay a set fee or co-insurance. You are not paying for future coverage, as you would with a deductible. Rather, you are paying for the services you receive as you receive them.
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