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.