What are Point-of-Service Plans?

When choosing what health insurance plan is right for you and your family, there are many options to choose from. A Point-of-Service (POS) plan is one of the options available to you. A POS can be thought of as a middle ground between HMOs and PPOs and has some characteristics of each. Under a POS you have more choices than you would with an HMO, and you don't have to meet deductibles they way you do with a PPO. Before going into the details of a POS plan, it is important to first clarify the terminology used in health insurance plans.

Health Insurance Terminology

• Deductible – The amount of money that you must first pay on your own annually before your health insurance plan will reimburse any medical expenses.
• Co-payment – The portion of the cost of treatment that you are required to pay under your health insurance plan. Once you cover your designated co-payment, your insurance will pay the remainder of the cost.

How POS Plans Work

Under a POS, you choose a primary care physician (PCP) for your plan, and this doctor addresses all of your health concerns. If your PCP cannot meet your specific health needs, they will then recommend a specialist within your network. An important detail of a POS plan is that you have to contact a specialist by first going through your PCP in order to receive in-network coverage. If you go to a specialist on your own, even if that doctor is in your network, it will be considered an out-of-network option.

As long as you stay within your network and always work with or through your PCP, you never have to pay a deductible under a POS insurance plan. This is a major advantage of the POS plan over PPOs, which have deductibles. The co-payment for a POS is also very low compared to other plans, though there are different co-pays for doctor's office visits, prescriptions, and medical treatments.

If you choose to see a physician who is out of your network or go to an in-network specialist without first consulting with your PCP, you are still somewhat covered under a POS, though you have to meet a deductible and make a co-payment in this case. The advantage to this system is that you have more doctors to choose from for your health needs and can still receive partial coverage for out-of-network physicians.

Choosing the Right Plan

If you do not have health insurance or are considering changing health insurance plans, you may want to consider the combined HMO and PPO benefits that a POS plan offers. However, a POS is not the best option for every family. To learn more about POS plans and other options available to you, contact a Texas health insurance agent from Option 1 Health Insurance today.