A Point of Service (POS) plan is a type of managed care health insurance plan in the United States that combines characteristics of the Health Maintenance Organization (HMO) and the Preferred Provider Organization (PPO) . Here are some key features of a POS plan:
- Enrollees in a POS plan are required to choose a primary care physician (PCP) from within the health care network; this PCP becomes their "point of service".
- The PCP may make referrals outside the network, but with lesser compensation offered by the patients health insurance company.
- For medical visits within the health care network, paperwork is usually completed for the patient.
- POS plans provide different benefits depending on whether the policyholder uses in-network or out-of-network providers.
- POS plans are similar to HMOs, but they allow customers to see out-of-network providers.
- POS plans are also like PPOs in that they still provide coverage for out-of-network services, but the policyholder will have to pay more than if they used in-network services.
- Depending on the specific plan design, POS plans may require the policyholder to get referrals from their PCP.
Overall, POS plans are designed to provide access to healthcare services at a lower overall cost, but with fewer choices compared to other types of health insurance plans.