Point-of-Service (POS) Plans - ByteScout

Point-of-Service (POS) Plans

The Point-of-Service (POS) plan is a flexible healthcare insurance plan, unlike other plans as it combines the characteristics of HMO and PPO plans. It allows individuals that purchase the plan to enjoy different benefits as they access healthcare from insurer accredited service providers (provider network) and non-accredited service providers.

Point-of-Service (POS) Plans

However, compared to PPO and HMO insurance plans, POS only accounts for a small percentage of all active healthcare insurance policies.

How it Works

POS insurance policy requires an assurer to select a primary healthcare doctor from a list of the provider network. It is then the responsibility of the doctor to refer the assurer to a specialist service provider if he or she sees a need for such an escalation. The doctor together with the assurer is free to select a specialist. This specialist can be within or outside the provider network as required.

Nevertheless, the assurer is likely to spend more in healthcare services received from specialists that are outside the provider network than those from within except if a primary healthcare doctor made a referral. In such a case, standard rates would apply.

The Core Characteristics of POS

  • Although the POS provider network is quite small, it offers insurance to its owners at reasonable rates.
  • It allows assurers to access healthcare services from providers that are not within the provider network.
  • The assurer must complete all necessary paperwork when accessing services from providers that are outside of the provider network.

POS plans generally have a reasonable premium rate compared to other types of healthcare insurance policies. It also requires copay from assurers for healthcare services regardless of whether they receive healthcare services from within the provider network or not.

Services such as consultation received from provider network would cost an assurer between $10 to $30 for every appointment. One significant advantage of POS over others is that services received from within provider networks do not require any deductibles.

POS may be cheap, but the savings obtained from it are limited. Nonetheless, the POS plan is available all over the country, and assurers that frequently travel can benefit a lot from this service.

Assurers should expect high rates of deductibles if they receive healthcare services outside the provider network. High rates of deductibles translate to assurers paying the entire cost of the treatment from their pockets until the deductible limit of the POS insurance plan is reached. As such, individuals that do not get healthcare services outside of the provider network would gain more by purchasing other insurance plans such as HMO due to its low premium rates.

Individuals that seek to purchase a POS plan may find some difficulty getting it as it only occupies a small share of the healthcare market. It is also significantly less marketed than most plans. As such, the POS insurance policy sometimes tends to be challenging to understand.

Therefore, potential POS assurers are advised to ask questions and compare the different types of policies to get the best fit for their unique circumstance.