Managed Care / Point-of-Service (POS) Plans

A POS is an HMO with the possibility to go out of the network.

The costs consist of a monthly premium, which is usually higher than the HMO one; a co-payment for health care services covered under the plan and within the POS network; and a deductible for non-network care (about $300 for an individual and $600 for a family). If you choose to go outside of the network, you may need to also pay a percentage of the costs after the deductible is met: the difference between your health care provider’s bill and what your POS insurer considers to be “reasonable and customary” for the service.

As with a HMO, you have to select a primary care physician from the plan’s list to become your “point-of-service”: he/she will manage all of your health care, approve further treatment, and refer you to specialists when needed. Unlike HMO, your physician can refer you to specialists outside of the network. In such cases, however, you’ll likely be subject to a deductible and, after the deductible is met, the co-payment will be higher than what you’ll pay within the network.

With POS plans, you don’t have to worry about paperwork if you use the network services. If you choose to go outside the network though, you’ll have to fill out the forms, send bills in for payment, and keep account of health care receipts.

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