Point of Service Plan
A type of health insurance plan that combines features of HMO and PPO plans, requiring you to choose a primary care physician but allowing out-of-network care at higher costs. You typically need referrals for specialists but have more flexibility than traditional HMOs.
Example
“With her point of service plan, Rachel pays only $20 to see her primary care doctor but would pay 40% coinsurance if she visited a specialist without a referral.”
Memory Tip
POS = 'Pick Our System' (in-network) or 'Pay Our Surcharge' (out-of-network) - you choose at the point of service.
Why It Matters
POS plans offer a middle ground between restrictive HMOs and expensive PPOs, potentially saving you money while providing more flexibility than HMOs. Understanding the referral requirements and cost differences helps you make informed healthcare decisions.
Common Misconception
Many people think POS plans work exactly like PPOs with primary care requirements, but POS plans typically have much higher out-of-network costs and stricter referral requirements that can significantly impact your out-of-pocket expenses.
In Practice
Lisa's POS plan covers 90% of in-network specialist visits with a referral, so her $200 cardiologist visit costs her $20. However, if she sees the same cardiologist without a referral, she pays 40% coinsurance ($80). If she goes out-of-network entirely, she might pay 60% of costs ($120) plus any amount above the plan's allowed charges.
Etymology
The term emerged in the 1980s managed care era, referring to the decision point where patients choose their level of coverage based on where they seek service.
Common Misspellings
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