Point of Service Plan

Point of Service Plan (POS) is known to be a type of managed care health insurance plan providing its members a reimbursement from any medical expenses. This plan is a combination of both the health maintenance organization and the preferred provider organization. In this plan, members are mandated to choose a primary care physician that will monitor the healthcare of the patient and if specialist is needed, it should be known by the physician. This chosen primary care physician must be within the network and will be considered as the point of service. Any potential visits to this chosen physician are all covered by the plan and most likely would require co-payment in which it is the joined payment towards coverage of the insurer in the medical costs. In addition, there is no deductible that is described as an advance payment before the full coverage begins in an insurance policy.

If in the event that one of the members would opt to go beyond the yard of the network, then the individual is solely responsible to pay for the deductible and he/ she may receive less benefits from the plan.

If in case the member needs care outside the network more than what the primary care physician can give, the physician has the power to refer his patient to other doctor and specialist. If this other physician belongs to the network of the POS plan, then the patient will be covered the same as the PCP. Specialist hired from beyond the network might need the patient’s payment for the deductible. Moreover, if services and visits are done by the specialist without the knowing of the PCP, then coverage is not included.

Upon choosing for a health insurance plan, it is the customer’s decision of whether to acquire a luxurious insurance of the best care or keep the insurance expenses down. This is the reason why most people would opt to enroll in a POS plan. A point of service plan is an all-in-one plan that balances cost of HMO at the same time with the flexibility of the PPO.

The major benefit of a Point of Service Plan is that it enables for more flexibility, compared to health maintenance organization, at the same time providing a justifiable cost control. Patients who need more significant care from the outside professional other than the primary care physician services may not be a good candidate in this point of service plan. In this case, a preferred provider organization, which demands for higher deductible and co-payments, may be the best option since this plans does not restrict limited options to its members and patients to a list of known network of capable physicians.

A point of service plan is a good option for medical coverage since it is a combination of benefits from HMO and PPO. But it is important to choose a medical plan which you think you need most considering main factors most especially when it comes to the cost.