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What Is a POS Plan?

A POS (point-of-service) plan is a hybrid of a health maintenance organization (HMO) and a preferred provider organization (PPO) plan. Boiled down to the basics, a POS plan functions like an HMO, in that it uses a network of covered providers. However, those enrolled in a POS may also seek treatment outside of that network, provided that they pay the difference in cost.

Where did the name “point-of-service” originate? When you need medical care at any certain “point” in time, it is your choice to let your primary care physician manage your care or to go outside the network without a referral.

POS plans do not mandate that those insured choose a personal doctor from a network. However, such a choice is recommended for effectiveness and efficiency in seeking medical care. If a patient does not have a personal physician, any visits he or she makes to a specialist may not be covered, forcing the patient to pay for the costs out-of-pocket.

Many people like the extra flexibility a POS plan provides, especially when compared to an HMO. HMOs mandate that patients visit only in-network doctors, and visits to any physician outside the network are not covered unless there are exigent circumstances. While an HMO may be less expensive, patients have fewer options in medical care.

By comparison, PPO plans offer a network of affiliated doctors, and subscribers do not have to go through a personal physician to make any kind of medical appointment. However, out-of-pocket costs are much higher than they are under an HMO, and PPO co-pays are much higher than those of POS plans.
To select a plan that works for you, consider the benefits, the cost and your health. Consult with your doctor for further suggestions to help you choose a suitable plan.

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