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Point-of-Service (POS) Plans

Point-of-service plans are major health insurance plans that bring together characteristics of both HMO plans and PPO plans. They are more flexible than HMOs, but they do require that you select a primary care physician (PCP). The PCP must make referrals in order for you to see any other health care providers.

Like a PPO plan, point-of-service plans normally cover a portion of charges from out-of-network providers, but it will be less than if an in-network provider is chosen. POS health insurance companies will usually make an exception if your PCP refers you to an out-of-network provider.

Point-of-service plans usually charge a small co-payment to visit an in-network doctor and most do not have a deductible.

Advantages of Point-of-Service Plans Disadvantages of Point-of-Service Plans
Choice of Doctor
If you see a non-network provider, most POS plans will still pay a percentage of the cost (it will be less than they would pay for an in-network provider unless you obtain a referral from a PCP).
Primary Care Physician Gateway
The PCP is the gateway to all health care services. You won't get complete coverage for a specialist without a referral. However, unlike an HMO plan, the POS plan will probably pay a portion of the cost even if you don't obtain a referral.
Small Co-Payment, no Deductible
The majority of point-of-service plans have small co-payments for medical services and treatments instead of a deductible. There is normally a deductible and bigger co-payment for non-network care however.
More Expensive than HMOs
Point-of-service plans tend to be more expensive than HMOs, but less expensive than PPOs.

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