Point of Service (POS)
Point of Service (POS) plans are sometimes called “Open Access HMOs” because they offer many of the advantages of an HMO (Health Maintenance Organization) but with an element of increased freedom.
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Advantages of Point-of-Service (POS) Plans
- Lower premiums than for traditional health insurance.
- Greater freedom than in a HMO. The member can choose whether to use network or non-network health care providers for each visit. (There are, however, incentives to choose a doctor within the network.)
- A member can choose their own specialist. No referral from a primary care doctor is required. (The POS plan offers incentives, however, for you to first seek a referral.)
Disadvantages of Point-of-Service (POS) Plans
- Usually have higher out-of-pocket expenses than for an HMO.
- If you choose a non-network doctor, your out-of-pocket expenses will be higher than if you choose a network doctor.
- If you see a specialist (such as a dermatologist or a cardiologist) without a referral from your primary care doctor, you will pay more of the costs than you would pay with a referral.
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Point-of-Service (POS) Product Details
POS plans are part of the “managed care” options available to you. As with the other options (PPOs and HMOs), a POS plan contracts with a network of health care providers (doctors, hospitals, specialists, etc.) in order to offer you a wide range of health care services at the lowest possible price. POS plans pass the savings on to the consumer in the form of lower out-of-pocket costs than in a traditional health plan.
A POS could be considered a hybrid between a PPO (Preferred Provider Organizations) and an HMO. It is called a “point of service” plan because you, the member, can choose at the point of service — that is, at any doctor’s visit or other time you seek a medical service — whether to use the PPO or the HMO option.
POS plans encourage, but do not require, you to choose a primary care doctor from within the network. As in a PPO plan, a member may choose to see a specialist without a referral from a primary care doctor but, in that case, the plan will only partially cover the specialist’s bill.
If you seek the lower out-of-pocket costs an HMO offers but want a bit more freedom, a POS plan may be for you.
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