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A Point of Service (or “POS”) plan is a cross between an HMO plan and a Fee-For-Service plan. In plain English, this means that, as a plan member, you get the benefits of affordable coverage with an increased freedom to choose your doctor or specialist. The potential drawback is that you pay a little more for the increased freedom.
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How POS Plans Compare
- Fairly Affordable
- Increased Freedom
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Important Points About POS Plans
- In order to keep costs down, a POS plan uses an approved network of doctors and other healthcare providers (hospitals, specialists, etc.). In this way, the plan is like an HMO.
- You choose a primary care doctor from the network. This person acts like a traditional family doctor to oversee your care.
- In most POS plans, if you need specialty care, you do not need to get a referral from your primary care doctor.
- Similarly, you can choose to see a doctor other than your primary care doctor at any time.
- If you do choose to see a doctor outside of the POS network, the plan acts like a Fee-for-Service plan. In this case, you are responsible for a larger part of the costs than you would be for a network doctor.
- Most POS plans cover preventive care, such as routine physicals, immunizations and health screenings. The idea is to keep you, the member, healthy rather than just treat you if you get ill.
- Most POS plans require little or no paperwork on your part, as long as you stay within the network. If you choose to visit a non-network doctor, you may need to pay for the services up-front and file a claim form for reimbursement.
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Different Types of POS Plans
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Copay Plans – These work well for people who make regular doctor’s visits, such as families with young children. You pay a small fee (about $10-$50) for each visit.
- Deductible Plans – These usually work best for people who don’t often need to seek a doctor’s care. Insurance coverage starts after you have paid a certain deductible each year.
For details on which insurance plans are offered in your area, please see the Texas-Health-Plans Providers List.
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