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What is a POS Healthcare Plan?

Mary McMahon
By
Updated Mar 03, 2024
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A Point of Service (POS) healthcare plan is a type of managed health insurance plan. It offers certain flexibilities that Health Maintenance Organizations (HMOs) do not. This type of healthcare plan is sometimes referred to as hybrid healthcare, because it mixes aspects of HMOs and Preferred Provider Organizations (PPOs) for greater patient autonomy.

Like all managed care plans, a POS healthcare plan is designed to provide efficient and effective patient service at costs which are as low as possible. It uses a network of preferred providers which patients must turn to first, receiving referrals to other providers if it is deemed necessary. Managed care ensures that patients get the medical attention they need, as long as they follow the system dictated by the insurance company.

Although it is not required, POS healthcare plans recommend choosing a personal physician from a network of approved providers. The patient sees the personal physician for all of his or her medical needs. In the instance of special needs, the personal physician is authorized to make a referral to another physician, who can be inside or outside the health insurance company's network. Patients without a personal physician may not be covered if they visit specialists. Patients who circumvent their personal physicians to go directly to a specialist may be forced to bear the cost themselves.

Most insurance companies have a national network of approved providers, ensuring health coverage throughout the United States. When patients need medical attention during trips, they can consult the health insurance company to get a list of local approved physicians. In emergency situations, patients should proceed to the nearest emergency room, whether or not it is in the health coverage network.

A POS healthcare plan offers more flexibility than an HMO, which requires patients to see only in-network doctors, starting with a personal physician. Visits to doctors out of the network will not be covered, except in special circumstances. Patients have fewer options in an HMO, although the plan may be cheaper, because the restrictive network allows the health insurance company to offer competitive rates.

This type of healthcare plan also differs from a PPO. In a PPO plan, patients can use doctors from within a network of affiliated doctors. Patients are not required to go through a personal physician, but the trade off means much higher out of pocket costs than with an HMO. Copays tend to be substantially higher under a PPO than under a POS healthcare plan, as well.

When selecting a managed care plan, there a number of things to take into account. Your health, the cost of the plan, and benefits are all important things to assess when examining healthcare options. If considering a healthcare plan which relies on a network of doctors and hospitals for care, you may want to inspect the list of approved providers before committing, to see if they will meet your needs. Your personal doctor can often assist you with selecting the best insurance plan for yourself and your family.

The Health Board is dedicated to providing accurate and trustworthy information. We carefully select reputable sources and employ a rigorous fact-checking process to maintain the highest standards. To learn more about our commitment to accuracy, read our editorial process.
Mary McMahon
By Mary McMahon

Ever since she began contributing to the site several years ago, Mary has embraced the exciting challenge of being a The Health Board researcher and writer. Mary has a liberal arts degree from Goddard College and spends her free time reading, cooking, and exploring the great outdoors.

Discussion Comments
By icecream17 — On Aug 29, 2010

BrickBack-That’s true. But I think that having an HMO is better than not having any insurance.

Although the options may be limited, it could save a large family a lot of money over time. I think that it depends on the circumstances. I actually rather have a PPO, in which there was no restriction on my health care provider and pay a little more out of pocket.

I do like that the HMO option is available as a choice for others because not everyone can pay the higher premiums like I do.

By BrickBack — On Aug 29, 2010

A POS health care system costs more than an HMO, but allows better flexibility in terms of care.

I was enrolled in a POS system once, and was able to see the doctor that I was currently seeing anyway. This doctor would not have been in the HMO plan, so I needed the POS in order to maintain my relationship with the same doctor.

The added expensive was well worth it. Also, with a POS, if you seek an out of network doctor, you will have to submit a claim and pay extra. I personally like these plans. I not want an HMO plan because, for me, I find the programs too restrictive.

Developing a relationship with the same doctor is important because over time it increases the quality of care that you receive because you doctor knows your medical history.

Mary McMahon
Mary McMahon

Ever since she began contributing to the site several years ago, Mary has embraced the exciting challenge of being a...

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