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Point of Service (POS) Plan
A Point of Service Plan gives you a flexible choice in selecting providers and reimbursement options when obtaining dental care benefits. You can apply to the network of providers and medical facilities as well as a number of individual, privately participating dentists working under contract with the insurance company. As an alternative, in case you need urgent help you may seek care from any dentist of your choice even if he/she is not a network provider. But in this case you will have to cover part of your dental care expenses out-of-pocket as your insurance provider will reimburse only a fixed percentage of the costs charged by non-participating specialists.
POS plans basically focus on covering preventive dental care, but also provide other types of benefits including emergency and surgical services. To make sure whether the services you may be in need of are covered by the policy of your plan you are recommended to carefully read the blueprint of your plan paying special attention to the evidence of coverage.
Usually when you choose a Point of Service Plan you also select a primary care dentist you will regularly see. Your primary care dentist will manage all your dental treatment and will authorize referrals to specialists and hospitals, if necessary. Each family member covered under a POS plan can select his/her own primary care dentist. Under DHMO plans you are also to choose a primary care dentist, but there is a difference between these two types of dental plans. With a DHMO plan you are usually bound to visit your primary care dentist if you want reimbursement for your dental care expenses. With a POS plan when you need dental care you may decide to see a non-participating dentist and you will still get reimbursement for the costs you incur. This provision is legally incorporated in your contract. However, if the preferred dentist does not belong to the network of providers, you will most likely have to pay more than if the dentist were part of the network. That is why if you are considering purchasing this type of dental insurance, you would rather find out in advance if your regular dentist belongs to the network.
It goes without saying that it is better, safer and more comforting to apply to the dentist you can rely on. With a Point of Service Plan you can take care of your convenience and plan your dental care expenses yourself.
In case you are dissatisfied with the treatment you receive you may change your primary care dentist for another dentist within the plan's network twice a year, though the actual term of receiving treatment from a particular dentist can vary depending on the contract. As soon as you have decided what dentist you would like to see, it is advisable to contact the dentist's office to find out if he/she accepts new patients. Otherwise you may be rejected assistance. Do not forget that together with a new primary care dentist you receive a new ID card and a new ID number. The customer service can be of great help in this situation. Normally, it takes 5-10 days to get a new ID card.
If you choose a non-participating provider as your primary care dentist, you are usually to meet an annual deductible first. Then, whenever you apply to a dentist for dental treatment, your insurance provider will reimburse a fixed percentage of the total cost of the services and you will be required a co-payment. You will pay only the remaining cost of the dental treatment and for what is above the UCR fee. It should be mentioned that most of POS plans have the out-of-pocket expense limitation for coinsurance, which means that your out-of-pocket expenses are limited each year to the maximum stated in the schedule of benefits. You should know that when you seek dental services from a non-participating dentist under a POS Plan your out-of pocket expense limitation is usually very high. After you have paid that dollar amount for dental care, you will not incur any additional payments as coinsurance till the end of the year.
One more advantage of POS plans is that they usually include the prescription drug benefit, which can noticeably curtail your dental care expenses. This benefit is provided only when it is prescribed by your primary care dentist and it normally requires a co-payment.
All in all, Point of Service Plans can be a cost-effective and reasonable option as under contracts of this type policyholders generally receive a high level of benefits and do not incur hefty expenses if they use network providers.