Point-Of-Service (POS)

The POS is based on the basic managed care foundation: lower medical costs in exchange for more limited choice. But POS health insurance does differ from other managed care plans. Consider them to be a cross between an HMO plan and a PPO plan.

Upon enrolling in a Point-of-Service plan, you are required to choose a primary care physician to monitor your health care, just like you would under an HMO plan. This primary care physician must be chosen from a health care network that participates and contract with your insurance company.

When receiving care through your primary care physician, or being referred to a specialist within the network of your primary care physician, you will receive more comprehensive benefits and pay less out-of-pocket for these services. However, you will not be limited to the services provided by this network. You also have the option to visit physicians and specialists outside of your primary care physicians's network of doctors. When using physicians that are associated with the PPO network of your insurance company, you will usually need to meet an annual deductible and pay a higher coinsurance percentage for these services. And, if you choose to go outside of the PPO network and use an "out-of-network" physician, your coinsurance will be even higher. For medical visits within the health care network, paperwork is completed for you. If you choose to go outside the network, it is your responsibility to fill out the forms, send bills in for payment, and keep an accurate account of health care receipts.

Point-of-Service (POS) plans are usually the most expensive type of health insurance, and are limited in availability.

Questions to ask about a POS:

• How many doctors and hospital are there to choose from in the HMO network?
• How many doctors and hospitals are there to choose from in the PPO network?
• How are referrals to specialists handled, both in and out of network?
• What health care services are covered?
• What preventive services are covered?
• Are there maximum annual benefits and limits oncrtain medical treatments or other services?
• How much is the health insurance premium?
• What are the copayments for physician visits and other specific services?
• How much more will it cost to use non-network physicians?
• What is the deductible and coinsurance for non-network care?
• Is there an annual out of pocket maximum, and how does it apply to your choice of physicians?