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Point-of-Service (POS) Plans

The most flexible plan, the POS, offers some of the cost advantages of a Health Management Organization (HMO) with some of the freedom-of-choice of a Preferred Provider Organization (PPO) health insurance plan. Basically, the POS provides more flexibility than an HMO and, generally, lower cost than a PPO plan. The decision to purchase a POS plan often hinges on whether the small-business owner believes the POS's freedom-of-choice is worth paying somewhat more than for an HMO plan.

Like an HMO, each covered individual designates a primary care physician from within the POS's network of participating providers. This physician serves as your "point of service," and all medical care passes through him or her. When you need a specialist, your primary care provider will refer you to a medical provider within the network.

Unlike an HMO, you have the option of requesting that your primary care physician refer you to an out-of-network specialist, though this will cost more to you than seeing an in-network specialist. Finally, you have the option of self-referring to an out-of-network specialist, but this will cost the covered individual even more.

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Among the advantages of a POS health care plan:

• The POS offers the covered individual a wider array of choices than either an HMO or a PPO, but this flexibility, depending on the choices made by the covered individual, may cost more out-of-pocket expense.
  
  
• Because the insurance company manages most care, premiums will likely be somewhat lower than for a PPO.
  
  
• For in-network care, co-payments are low and there is no deductible for covered individuals and families.
  
  
• For care within the POS's network, paperwork will be completed for you. However, if you choose to seek out-of-network care, you will be responsible for filling out forms, sending in bills for reimbursement, and keeping an accurate record of medical and pharmacy bills.
  
  
• Charging a fixed premium for medical care within the POS's network, the POS has an incentive to place a high priority on prevention and health education to avoid potential medical issues.

Some employees prefer POS health insurance plans because they control costs like an HMO but still provide some coverage if the covered individual decides to seek care from a non-network physician.

Request a Small Business POS Quote from a carrier in your area >>