When it comes to managed care options, point of service (POS) plans can offer a lot of flexibility and a wide array of options to policy owners on their health care plan. As an example, policy holders can select a plan that has either partial or full coverage for providers that are not part of the network, as well as full coverage on health care visits to network providers.
The biggest advantage of a point of service plan is that policy owners can opt to either see both network as well as non-network providers. They also are not required to decide until it is time to see a provider. With other types of plans, such as HMOs, users must only choose network providers. There is not an option to see non-network providers even if the individual is willing to pay higher costs.
POS plans do have some similarities with HMO and PPO plans. Just like an HMO plan, patients do not pay deductibles when they utilize network providers. However, there is usually a small co-pay when one sees a network provider. The amount is usually around $10 to $15.
Another way in which POS and HMO plans are similar is that both types of plans require users to select primary care doctors that are members of the insurance carrier’s provider network. However, one major difference is primary care doctors are able to refer policy holders to any specialist, whether the specialist is in or outside of the network. Whether the specialist is part of the network or not, the insurance company will pay most of the costs of seeing a specialist.
The difference is referring out to a non-network specialist means that the policy holder will have to pay a deductible and a larger co-pay. In this way POS plans work more like PPO plans. In these situations, a co-pay could be as much as 40%. The policy holder will also need to complete paperwork for the visit.
The yearly deductible on non-network health care usually runs $250-$300 for individuals and $500-$600 for families.
A majority of POS plans will provide coverage for these type of expenses:
- Primary care doctor visits
- Visits to specialists that your primary care doctor has referred you to (whether the specialist is part of the network or not)
- Diagnostic lab services and tests
- Emergency services
- Hospital services ( this includes both out and in patience services as well as diagnostic procedures)
- Preventative health care services, including checkups and vaccinations
- Prescription medicines
- Some plans also cover dental care
POS plans are useful for any individual who would like to have flexible health care insurance as well as have the ability to visit specialists without needing to worry about whether the specialist is part of their insurance carrier’s network or not for keeping expenses down.
However, selecting non-network providers on a consistent basis can get expensive quite fast. PPO plans are best suited for families and individuals who can see network providers for most of their health care needs, but would like to have the option of choosing non-network specialists when it is a necessity. If having the ability to self-refer is an important consideration, than PPOs are the ideal type of plan to choose.
