Point-of-Service Plan

What Does Point-of-Service Plan Mean?

A point-of-service (POS) plan is a health care plan that allows a person to choose from a primary care physician in the network. While the choice is limited, a POS offers medical care at a low cost. If the primary care physician cannot provide the care required by the patient, the former can refer someone from outside the network. Out-of-network physicians will then receive compensation that is often lower than those offered by other types of health insurance, namely health maintenance organizations (HMOs) and preferred provider organizations (PPOs).

Insuranceopedia Explains Point-of-Service Plan

A point-of-service plan is a managed health insurance plan that offers a mixture of the features of the more common health plans, namely health maintenance organizations (HMOs) and preferred provider organizations (PPOs). It is similar to a PPO in that it allows the patient to designate a primary care physician within the network, who becomes the "point of service" to the patient. On the other hand, it is also similar to an HMO as it allows the patient to ask for referral from a POS physician to seek medical care from an out-of-network physician. In case of medical visits to out-of-network physicians, the patient is responsible for filling out the necessary forms, paying excess out-of-pocket costs, and taking account of any medical care receipts.

While limited in service in a sense, it offers medical care at a rate quite lower than the other types of plans. Oftentimes, with POS plans, primary care physician visits are not susceptible to a deductible. So, this can be viewed as a very positive aspect of POS plans. Many people obtain POS health insurance plans through their employers. Joining an employer-sponsored health insurance program is often easier and less costly than purchasing an individual plan.