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POS Health Insurance Plans

A Point of Service (POS) health insurance plan is a managed care plan that is a hybrid arrangement of certain characteristics of both PPO plans and HMO plans. The POS plan is built on the old Health Maintenance Organization (HMO) model of services but has instituted much of the flexibility that is inherent with PPO plans. Many POS plans have been developed in response to the shift in public sentiment away from traditional HMO plans and towards the much more flexible PPO plans.

In a POS plan, plan participants elect whether to receive medical care in network (for a healthy discount) or out of network at the physician or facility of their choosing (without the in network discounts). This is contrasted to the traditional HMO model where HMO members have no out of network benefits at any time (except for sometimes in the case that emergency services are needed). In other words, with an HMO plan you will be as if you do not have health insurance if you needed to go to an out of network medical provider while with a POS plan you would simply pay a higher rate (much like many Preferred Provider Organization (PPO) plans that negotiate substantial in network discounts for their members).

There are two main types of POS plans: the open-ended HMO POS plan and the gatekeeper PPO POS plan. The open-ended HMO POS plan is definitely the most popular form of POS plan. The open-ended HMO POS plan can be thought of as being almost exactly like an HMO plan except for the very important fact that members are allowed to go out of network and receive medical care. Typical characteristics of HMO plans include having to choose a primary care physician and having to obtain referrals from the primary care physician (sometimes call the “gatekeeper”) in order to see a specialist.

The gatekeeper PPO POS plan is much like the PPO plan. In fact, some POS plans have almost no discernible difference from typical PPO plans. Typical characteristics of PPO plans include the freedom to choose any primary care physician that you like (and switch PCP’s at any time quite easily), going directly to a specialist without a referral, and choosing to go to any doctor that you prefer. In some gatekeeper PPO POS plans plan participants must elect a primary care physician that they must then notify when they seek out of network care or specialist care while in some other POS plans one is not required to notify their PCP or even choose a PCP at all.

POS health insurance plans can be somewhat confusing in the sense that they can differ quite dramatically in how they function. Some POS plans resemble the HMO model and others more closely resemble the PPO model. In a nutshell, if you seek the flexibility of being able to choose any physician or facility that you like (and the ability to freely switch to other medical providers without a hassle) then you will probably prefer a PPO plan or a POS plan that functions like a PPO plan. If you do anticipate the need to every use out of network services and the HMO plan you are investigating is more cost effective then an HMO plan or a POS plan that functions like an HMO plan may be a good option for you.

Do your research before you choose a health insurance plan. Let the transparency and ease of the Internet help you to make an informed decision. Use our free health plan finder to compare plans and networks from all of the top health insurance companies in your area. Take just a few moments and compare free health insurance quotes now!