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Point of Service (POS) - An Overview

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Point of Service (POS)

Some Useful Information on Point of Service (POS)

Over the years, the concept of managed care has given rise to three important kinds of health insurance plans- Preferred Provider Organization (PPO), Health Maintenance Organization (HMO) and Point of Service (POS). The last two are intrinsically connected by way of functioning but the main difference lies in the cost of the two. While HMO plans are pricey, their POS counterparts are more affordable. In fact seen objectively, POS plans combine benefits of both PPO and HMO plans but lie somewhere in the middle in terms of affordability. POS plans are usually of two types- one that combines the characteristics of HMO and traditional indemnity and the other that packs HMO, PPO and traditional indemnity into a single comprehensive package.

So what characterizes a POS plan? The very first thing is perhaps the presence of a Primary Care Physician (PCP) that reminds one of a health maintenance organization. The next is the freedom given to members to choose coverage according to their preference and convenience. This aspect is in tandem with the basic nature of a Preferred Provider Organization. But do note that POS plans do not exactly support members going out of the provided network to avail services. This is precisely why they offer the benefit of lesser prices when all activities are carried out in- network.

Despite being closer to HMO plans in practice, POS’s can be distinguished based upon the following points. Unlike an HMO plan, members with a POS plan do not have to pay every time they make office visits or avail other services. POS plans, as a rule, have made it necessary for Primary Care Physicians to work against a fixed fee per person, no matter how many services the member avails. Since they do not have control over the fee amount, PCP’s in such cases tend to put a check on the number of services the member can make use of. People opting for POS plans under group coverage can go beyond the network to get specialized services but they must be ready to pay higher deductibles and co- payments. Costs reduce considerably when group coverage holders choose to get medical help within the confines of the network, under the guidance of the PCP.

POS plans are quite advantageous for members due to the HMO- PPO combination. The presence of the Primary Care Physician makes it easier for members to earn discounts. In fact, thanks to the PCP, your cost on a POS plan could get slashed by upto 15%. Apart from this, POS plans have won over advocates over the years due to their flexibility. And the best thing about these plans is that despite being flexible they do not compromise on quality. This means members get to exercise their freedom over qualitatively superior health plans at affordable rates.


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