Point of Service Health Insurance Plans

By Compuquotes Team on August 1st, 2008
Health Insurance

Point of Service plans are very flexible managed care options that provide policy owners with a wide variety of options for their healthcare plan. For example, users can choose a plan with either full or partial coverage for non-network providers, in addition to full coverage for healthcare visits to providers within the network.

Perhaps the biggest advantage of POS plans is that a policy owner has the option to choose from both network and non-network providers, and does not have to make that decision until they actually need to visit a provider (whereas other plans, such as HMO plans, require that users choose only network providers, and do not offer the option to visit non-network providers, even at higher cost).

POS Plans: The Basics

POS plans share some similarities with both PPO and HMO plans. As with an HMO plan, users do not pay a deductible when they use network providers. However, visiting a network provider does involve payment of a small co-pay of around $10 to $15 depending on the plan.

Another point of similarity between POS and HMO plans is that both require that the user chooses a primary care doctor that is a member of the provider network of the insurance carrier. However, a major difference is that a primary care doctor can refer a policy owner to any specialist, whether in or out of the carrier's network. Regardless of the specialist's network status, the carrier will cover most of the cost of the visit.

The difference lies in the fact that self-referring to a specialist who isn't in the carrier's network means paying a deductible, as well as a larger co-payment. In this respect the POS plan operates more like a PPO plan. In these cases, the co-payment may be up to 40%, and will also require that the policy owner completes some paperwork associated with the visit.

Annual deductibles for non-network healthcare typically run to approximately $250-$300 for an individual, and $500-$600 for families.

What do POS Plans Cover?

Most POS plans provide coverage for the following types of expenses:

  • Visits to your primary care doctor
  • Specialists your primary care doctor refers you to (regardless of the specialist's network status)
  • Diagnostic laboratory test and services
  • Hospital services (including in and out patient services and diagnostic procedures)
  • Emergency services
  • Prescription medications
  • Preventative healthcare (including vaccinations and routine check-ups)
  • Some plans may also cover dental care

Who should use a POS Plan?

POS plans are suitable for anyone who wants flexible healthcare insurance, and who wants to be able to visit specialist healthcare professionals without having to worry about whether the specialist is in their insurance company's network to keep the costs down.

However, note that choosing non-network providers consistently can become expensive very quickly. These plans are best for individuals and families who are able to visit network providers in most situations, but want the freedom to choose non-network specialists when necessary. If the freedom to self-refer is important, this is an ideal plan to choose.

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