What is Point of Service (POS) Health Insurance?

A Point of Service (POS) health insurance plan provides access to health care services at a lower overall cost, but with fewer choices. Plans may vary, but in general, POS plans are considered a combination of Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans. You can access care from in-network or out-of-network providers and facilities, but your level of coverage will be better when you stay in-network. If you have a point of service plan, depending on your specific plan design, you may be required to get referrals from your Primary Care Provider (PCP).

What does “point of service” mean?

The term "point of service" refers to where and from what provider you receive services. Your coverage varies depending on whether you see a provider who’s in- or out-of-network and if you’ve received a referral, if required by your plan.

How do point of service plans work?

Like an HMO, you start by selecting a Primary Care Provider (PCP) to help coordinate and manage your health care needs. Your costs for care will be lower if you see in-network providers. Like a PPO, you have choices about where to receive care. Your PCP may refer you to in-network specialists, if your particular plan requires it. You are also free to see out-of-network specialists, without a referral, but you could pay more for that flexibility.

What are the pros of POS insurance?

• Your health care costs are typically lower when you get care from in-network providers.
• You can see a specialist outside of your approved network – and be covered, but you may pay more out-of-pocket.
• When you receive in-network treatment and services, the paperwork is usually done for you.

What are the cons of POS insurance?

• Depending on the plan you choose, you may need to get a referral from your PCP to see in-network specialists.
• If you access care from outside your network, your health care costs may be higher.
• When you get out-of-network care and services, you may be responsible for all related paperwork, including managing the receipts and bill payments.

Are POS insurance plans all the same?

No. The above is a generic description of traditional POS health plans. Depending on the plan design and the insurance provider, the features of a POS plan may differ, as well as plan name.

POS insurance works best if you’re willing to follow the terms of this type of health plan. If you’re comfortable selecting a PCP to manage your care, this plan may be right for you.

Remember, even though a POS plan might have an overall lower cost, you may pay higher costs if you need to see a provider that’s outside your plan’s network. It’s worth checking to make sure the providers you normally see are in-network for the plan you’re choosing.