insurance programs

Point of Service (POS) insurance programs are a combination of the benefits you would receive from a PPO or HMO. POS insurance does not usually involve deductibles. Like an HMO, POS programs require you to have a Primary Care Physician (PCP) who acts as your point of service for all other medical needs. The PCP that you choose under a POS plan then refers you to specialists. A low copay usually covers fees for services under a POS insurance plan. Depending on the POS plan and the state you reside in, the copay cost can be anywhere from $10 to $30.

Unlike an HMO, POS insurance programs allow the customer to choose doctors and hospitals outside of the POS network. Coverage of services outside the POS network is an average of 60%. Further, many POS insurance programs often require a deductible to be paid for services outside of the POS network. Fortunately, even with deductibles, POS insurance programs usually have low out of pocket cost limits. The average POS out of pocket limitation is $2,400 for individuals and $4000 for families.

One of the complaint people have about POS services is that their PCP does not give them appropriate referrals. Having to request a referral from a PCP is an additional step in accessing needed POS medical services. You can always skip this step by seeing someone outside the POS network, but doing so can prove quite costly.

A benefit of PCP referrals is that the PCP can refer you to a doctor outside the POS insurance network. A PCP referral outside the POS network significantly reduces the portion of the billing that you would be responsible for.

Overall, POS programs allow for greater freedom of choice in health care options by combining the flexibility of a PPO with the low cost of a HMO. POS insurance programs can seem restrictive because they require referrals from a PCP in order for the POS coverage of medical expenses to be maximal. This means that while POS insurance programs offer greater freedom of choice, this freedom is regulated by the PCP. There is still the choice to seek service outside the POS network, but that may incur large fees. Having a POS insurance plan means recognizing the balance within the POS plan so that you can plan for a balance in POS benefits and services for yourself.