Point of Service Plans

These days, people shopping for health insurance have plenty of options. Point Of Service plans, or POS plans, are a combination of managed care and traditional “indemnity” coverage. They give you savings and choice — the best of both worlds.

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Two Levels Of Health Coverage

Like an HMO plan, in a POS plan you choose a Primary Care Physician. The Primary Care Physician coordinates your care, and refers you to specialists within the network for treatment. You can also choose to see any provider outside of the network. A POS plan will reimburse you for that care, just like a traditional indemnity plan. But the reimbursement typically won’t be for the entire costs. In the end, it will end up costing you more to go outside the plan network for care.

These two levels of coverage are called “in plan” and “out of plan.” In plan benefits are more generous — they’re also more restricted. Like an HMO plan, getting full coverage on the “in plan” level requires a referral from your Primary Care Physician. It also sometimes requires pre-approval from the plan administrator.

That means that even if you stick to doctors and hospitals within the plan’s network, you won’t receive full “in plan” benefits without a referral. One of the biggest complaints about managed care is the “red tape” involved in getting care. But compared to traditional plans, the savings managed care offers are enormous.

The Advantage Of Indemnity

One of the reasons that POS plans enjoy popularity is that by providing indemnity coverage, they are far less restricted than regular managed care plans. Like PPO plans, you’ll still receive coverage when you choose a doctor outside the plan network.

This means that you can “self-refer” for specialist care. When you need treatment, you can choose any doctor you want, without having to get approval from your Primary Care Physician. But without the approval, you won’t get as much coverage.

This flexibility lets you jump over the restrictions that are common in HMO plans. If you have a long-time family doctor that isn’t part of the plan network, you can continue to see them. But the “coinsurance” payment for each visit may be as high as 40% of the total cost. If you use a doctor within the network, the cost may be as low as $10.

Finding Your POS Plan

To learn more about finding a POS plan that’s right for you, talk to a professional insurance agent.

When you use our free quote service, you’ll be matched with agents in your area who can tell you more about specific plans you qualify for. All you have to do is fill out a short form to request your free insurance quotes. Filling out the form only takes minutes. Comparing plans is fast, easy, and free.