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POS Health Plans

Point of Service Plans — POS Plans, Coverage & Quotes

What is a POS insurance plan? A POS plan is a cross between a PPO and a HMO. The POS health plan controls most of your health care, but offers some degree of freedom. POS plans allow you to go to both in-network and out-of-network hospitals and physicians. Staying within the network is more affordable. If you utilize medical care outside the preferred network, you will not be able to take advantage of the discounted rates POS health insurance plans negotiate with their preferred providers. Instead, you will need to pay a significant percentage of the bill.

The first step you must take after buying a POS insurance plan is selecting a primary care physician (PCP). What is it that gives a POS insurance plan its name? POS plans make your primary doctor the “point of service” for health care. If you want to see a specialist, you must first receive a referral from that doctor. However, that doctor is allowed to refer you to any specialist regardless of whether or not they are in the network. If you are referred to an outside specialist, your PPO medical plan will cover the visit at a lower rate–unlike a HMO, which would leave you with the entire out-of-pocket cost. Therefore, a POS can be of use if your doctor recommends a renowned specialist, or one for a relatively uncommon specialty unlikely to be in many networks.

When you stay within your POS health insurance plan’s network, it is more affordable and convenient. POS insurance plans usually handle all of the claim paperwork for you. If you go outside of the PPO’s network, those tasks become your responsibility in order to receive reimbursement. A POS healthcare plan may also refuse to cover any specialist visits if you go against your primary care physician’s recommendation. In those cases, you may have to pay the whole cost of the treatment immediately.

POS health plans reduce your out-of-pocket costs. Premiums and co-payments are less expensive under POS plans than with PPOs, but more costly than HMOs. You are not able to practice “self-referral” within the network. There is no deductible for in-network care on most POS health insurance plans, although deductibles, co-payments, and co-insurance amounts rise if you go outside of the network. With health insurance, there is always a trade-off between flexibility and cost.

When looking for a health insurance POS plan, you should consider the size of its provider network, as well as its cost. If you would like to continue seeing a certain doctor or specialist, check to see if they are on the provider list for a particular POS health plan. Doctors may work with multiple POS plans, or be exclusive to one health insurance company’s network.

If you are considering a POS plan, VitalOne can help. Our licensed health insurance agents are available to provide quotes and compare the coverage offered by several major POS insurance plans.

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