One category of managed-care health insurance combining elements of both HMOs and PPOs is a Point of Service (POS) plan. Basically, the plan is a type of HMO that permits selection of doctors. The insured chooses who gives medical service because he or she pays at the point of service (POS) if the care is out-of-network.
In a POS plan, the insured pays less to use in-network providers, and may have a primary physician in that group. However, a doctor outside the network is consulted, then the plan will pay a smaller amount – unlike a true HMO, which reimburses only for services within the network. Costs are lowered because of the discounts available within the network.
Request more information about Ohio POS plans NOW!
Advantages of a Point of Service Plan:
- Out-of-pocket fees are greater than for a true HMO, but can be less than for a PPO if network providers are used.
- Individuals in a family may elect to have separate primary-care doctors.
- Bills can be substantially reduced by using the preferred provider list and choosing a primary care physician from that list.
- There is the option to choose a specialist without a referral, but the out-of-pocket expense may be greater than with a referral.
- Preventive care is a primary concern.
Disadvantages of a Point of Service Plan
- Out-of-pocket fees are greater than for an HMO.
- If you choose to use out-of-network care, you may need to pay up-front and then file a claim. It usually is not necessary to file claim forms for in-network care.
- The patient must get pre-certification for all hospitalizations and most elective treatments.
Request more information about Ohio POS plans NOW!
Point of Service Plan (POS) Plan Details
The core of a POS plan is to reduce fees by managing care and by encouraging use of a group of providers that offer deep discounts to the insured. The governing board of the POS plan decides which treatments are eligible under the plan. POS plans emphasize preventive care coverage and staying well.
POS plans are more lenient than the traditional HMO. POS plans also permit patients to choose their providers and to change doctors at will. A portion of out-of-network costs is covered. Some POS plans have deductibles while, in other plans, the patient pays a co-pay for each doctor visit. Premiums vary according to the size of the deductible or co-pay.
