Frequently Asked Questions

How do point of service (POS) plans operate?

Combining the features of both preferred provider organization (PPO) and health maintenance organization (HMO) plans, a POS plan provides cost incentives to encourage patients to select primary care physicians from its network of doctors. The patient won't have to pay upfront for services provided within the network, but still will be able to submit a claim for services provided outside the network. Ultimately, this plan offers the greatest choice, enabling the member to choose the type of service they are receiving once they begin receiving care for a problem. POS plan members have three choices to make at their "point of service": 1. Go through the POS' primary physician and receive coverage like that of an HMO. 2. Elect to receive care through the plan's PPO provider and receive coverage under "in-network" guidelines. 3. Opt to go with healthcare both outside the primary physician or the PPO network and receive care under "out-of-network" guidelines. In short, a POS acts like a PPO, HMO and indemnity plan all at once, and the member can choose which approach to take at the time he or she begins receiving care at the point of service. A POS plan offers maximum flexibility, but deductibles and high co-payments for non-network care.

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