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Point Of Service Plans

A Point of Service (POS) plan is a managed health care insurance system that blends features of both the Health Management Organization (HMO) and the Preferred Provider Organization (PPO). It is similar to HMO because you do not pay any deductible and usually pay only a minimal co-payment when using a health care provider belonging to your network. You also have to select a primary care physician who is responsible for all referrals within the POS network. Once you opt for someone outside the network for health care, the POS plan functions more like a PPO. You are likely to be subjected to a deductible and the amount of your co-payment will be a considerable percentage of the physician's charges.

Under a POS plan, you get a maximum freedom of choice. Similar to a PPO, you can also mix the types of care you get. If your child is sick, he or she can continue to get treatment from his or her pediatrician who may not belong to the network, while you receive the rest of your healthcare from network providers. As it happens with an HMO, you need to pay only a small amount for network care. In most cases, your co-payment will be about $10 per treatment or office visit. You, however, maintain the right of seeking care outside the network at a lower level of coverage.

In case you decide to use network providers, you usually need to pay no deductible. In this way, coverage starts from the first dollar you spend as long as you choose to stay within the POS network of physicians. If you are willing to go beyond the POS network for health care, you can consult any doctor or specialist of your choice without first consulting your primary care physician (PCP). You should, however, remember that you must pay much bigger out-of-pocket charges for non-network treatment. The payments you have to make out of your own pocket, such as deductibles and co-payments, are limited.

The disadvantage of a POS plan is that you are required to cough up a big amount, sometimes nearing 40 per cent of the cost of treatment, if you visit a doctor not belonging to the POS network. So if your family doctor is outside of the POS network, you may continue to consult him/her, but only at a much greater cost. More often than not, you must reach a specified deductible before coverage begins on out-of-network care. This deductible amount is over and above the co-payment for out-of-network care.

As you need to do in an HMO, you have to choose a primary care physician. Your personal care physician provides your general medical care and he or she must be consulted before you go for treatment from another doctor or specialist within the network. Although this process of screening helps to reduce costs both for the POS and for POS plan users, it can also create complications if your physician fails to provide the referral you are looking for.



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