Individual POS Health Plans

Point of Service Plans — POS Plans, Coverage & Quotes

A POS plan, otherwise known as a point of service plan, combines aspects of HMOs and PPOs. It is a type of managed care that offers a certain amount of freedom, although most of your care is still controlled by your POS health plan. POS plans work with a preferred network of doctors and hospitals. These networks have contracted to provide health care services to POS patients at discounted rates. You can go outside the POS network if you choose to.

Unlike a PPO, a POS insurance plan requires you to select a primary care physician (PCP). POS plans get their name from the fact that your primary doctor becomes your “point of service”. You will first need to get a referral from your primary doctor if you want to see a specialist. He or she can then refer you to a specialist that is either in- or out-of-network. If you are referred to an outside specialist, your PPO medical plan will cover the visit, albeit at a lower rate. In contrast, a HMO would force you to pay the entire cost of the visit out-of-pocket. Therefore, a POS can be useful if your doctor suggests that seeing an industry expert not covered under your plan is ideal for your health.

Still, the savings–in both time and money–are greatest when you stick with your POS health insurance plan’s network. POS insurance plans typically handle the paperwork for you. When you utilize services within the network, you don’t have to worry about filing claims or receiving reimbursement. If you go outside of the PPO’s network, those tasks become your responsibility. A POS healthcare plan may also refuse to cover any specialist visits if you ignore or fail to select a PCP. In those cases, you may have to pay the whole cost of the treatment immediately.

Your out-of-pocket cost is reduced with POS health plans. Premiums and co-payments are less expensive under POS plans than they would be under a PPO. This is because you give up some of the flexibility a PPO offers, such as the ability to self-refer. There is also no deductible on most POS health insurance plans, as long as you stay within the network. However, individuals can pay about $300 annually on deductibles for out-of-network care; this is on top of the increased co-payments and co-insurance percentages. A POS plan does offer greater freedom than an HMO; as a result, that benefit must be traded off with higher costs. It is the mid-range cost option in the managed-care plan market.

What is important for an individual seeking a POS insurance plan? While it is essential that the cost of the health insurance in a POS plan fits your budget, it’s not the only thing you should consider. When selecting a POS health plan, think about the approved providers each one covers. Take a look at the list of doctors in the POS plan’s network. Is there a specific doctor want to continue seeing? If so, make sure they’re on the list. Do the same for specialists that treat any conditions that may result from your current health status. Moreover, make sure that the primary care physician you choose is someone you like and trust. One of the main pitfalls with a POS plan is conflict with a doctor that refuses to give you a referral you need in order to take advantage of lower in-network co-payments.

VitalOne has licensed health insurance agents available to help you decide among POS insurance plans. We provide quotes from a variety of major POS plan providers and can assist in comparing coverage.

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