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Index | Health Insurance | Point-of-Service (POS)



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Point-of-Service (POS)

Point-of-service (POS) health care plans combine the features and benefits of Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO) plans, offering the freedom characteristic of a traditional Indemnity Plan. Point-of-Service plan is considered the least restrictive type of Managed Care.

Basically, POS offers more flexibility than HMOs. Like HMOs, POS plans also have a network of health care providers who offer their services to plan members and choosing a Primary Care Physician who makes all decisions regarding a member's health-related issues, is a requirement.

Like in PPOs, there are lower fees within a network of health care providers. However you have an opportunity to receive medical attention from out of network too and you will still be covered to some extent. However, you must get a referral to a specialist or hospital from your PCP first. If your PCP is unavailable, he/she should settle your health care with another participating physician. In case you receive medical services without coordinating your care through your PCP first, your expenses associated with the claims will be higher.

When your PCP refers you to a specialist out of the network, the plan usually bears most of the cost. With POS, you can also choose to refer yourself, but it will be more expensive and complicated for you, meaning smaller compensation and more paperwork.

There is a higher in-network utilization which results from the supervision of care by an in-network PCP. This makes the costs for POS plans lower than for PPO. When you use a healthcare provider within the POS network system, you don't have to pay deductible and the co-payment will be minimal. Outside of the network POS members are exposed to excess charges or deductibles.

While PPOs require members to select a preferred provider in advance, with a POS plan you can choose whether to receive medical treatment within your plan's network or outside the network right at the time you require health care. Depending on the decision a plan member makes at the "point of service," POS can perform functions of an HMO or PPO, or can resemble an Indemnity plan in its features.

POS plans may also offer coverage for a variety of preventive care services. If you are a member of POS, you can have access to some health improvement programs as well and get a discount at a health club, join workshops on proper nutrition or smoking cessation, etc.

People who belong to POS plans should be well aware of the financial aspects of the choices available to make the right decision. A POS product has its specific mechanisms of providing medical services to members.

Basically, there are three options the POS plan member can choose from when he/she faces the necessity of a medical assistance. The member may select a Primary Care Physician from the network to direct all his/her health care (usually a family practitioner or general internist) and then all medical services will be covered according to the rules of HMO plan. In-network health care is the most convenient and economical care type. There is no deductible and the co-payments are low for network care. The PCP can make referrals outside the network as well, however in this case the compensation offered by the POS member's health insurance company will be limited.

The POS plan member can also receive medical care through a PPO provider. According to this scenario, the services will be covered under in-network PPO rules. A co-payment and coinsurance are necessary in this case.

You also have an opportunity to acquire medical services from a provider outside of the HMO and PPO networks. When the specialty or major medical care is reimbursed under the out-of-network rules, a co-payment, higher co-insurance and deductibles are normally required.

Within the health care network paperwork is normally completed for you by your physician. Outside the network it becomes your responsibility to fill out all the forms, and send the bills for payment. Always remember to keep an account of health care receipts.

When deciding which Health Insurance plan to choose, compare the options and benefits various plans offer and talk to an independent insurance agent to ensure your selection is well-considered and most suitable for your situation. Shopping around is most recommended since rates and coverage may vary considerably from state to state. A POS plan might be the right choice for you if you appreciate the convenience and low cost of in-network health care providers and freedom of provider choice at the same time.

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