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POS (Point of Service) health insurance benefits explained

When it comes to health coverage these days, we sure have a lot of various options to choose from. One of such options, which has become quite popular lately are Point Of Service (POS) plans that can be viewed as a mix of traditional indemnity and modern managed coverage options. And what such a combination provides you with are money saving potential and flexibility, all in a single package.

  Health coverage on two levels at once

People familiar with HMO plans can easily see the similarity between HMOs and PPOs when it comes to organizing the services. Here you are also required to choose a PCP (Primary Care Physician), who will coordinate your services and provide referrals to other specialists within the network when required. But you are also free to choose any facility or physician that doesn't make a part of the specified network. And a POS plan will pay for such services out of the network, however to a narrower extent than with in-network services. So it will still cost you less to get your services within the POS network.

This is what is meant by two levels of insurance coverage, which are called “in plan” and “out of plan” health insurance. In plan coverage is usually more advantageous but it also has tighter restrictions imposed on the user. Like in case of HMO plans, in order to get full coverage at the “in plan” level you will have to provide a referral from your PCP and get your services within the network. You will also sometimes be required to get additional approval from your insurance administrator beforehand.

This all means that even sticking to the specialists and facilities of your POS network won't give you full coverage unless you provide a referral from your PCP. This is the so called “red tape”, which is one of the biggest complaints about managed insurance plans and the formalities within them. However, when compared to indemnity plans, managed health care provides substantial money saving possibilities that can't be beaten.

  The indemnity part of POS

POS plans provide the best of both worlds, that's why they are so popular. And when it comes to the indemnity part of POS plans, people find a lot of flexibility and freedom that just can't be obtained through typical managed care options. Just like in the case of PPO plans, you are still able to get insurance coverage even when addressing to a specialist outside of the POS provider network.

In other words, you can use “self-referrals” in order to get care from a specialist you choose. When treatment is required, you are free to choose any physician or facility without needing a special referral from your PCP, Still, you won't get much coverage when choosing this option, so flexibility still has its price.

However, this is a great way to avoid the restrictions typical for managed care plans. That will be very useful for those who have a long-term trusted physician outside the network. Still, in such a case you will have high co-insurance payments (up to 40%) that will make your visits a bit more costly if compared to a doctor from the POS network.

  Finding the right plan

In order to get cheap health insurance with your POS plan you have to shop around first. Try getting as much health insurance quotes from different providers as you can, compare them and choose the right policy.


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