Health Insurance Articles
Why Many Consumers Prefer POS Health Insurance
2010-02-05
A hybrid of HMO and PPO health insurance systems, the POS health plan is becoming a popular mid-range option for health care. In an attempt to combine the lower cost of a Health Management Organization with the flexibility of a Preferred Provider Organization, a Point of Service health plan aims to provide the best of both worlds in terms of both doctor availability and price.
With POS health insurance coverage, the client is encouraged to choose a primary care provider, or PCP, and visits to that doctor will be covered under the POS plan's mandate. The PCP will then refer the client to any more specialized services they need. The PCP will be a doctor from within a network of physicians that have agreed to provide services at a discounted cost. Likewise, they will try to refer patients to specialists, which are also under the same network umbrella. If using any in-network services, such as a PCP or specialist, the client is typically responsible for simply a co-payment and a monthly premium, which is typically much lower than in a PPO system. No insurance claim forms need be filled out if the care given is within the network. These plans can be especially beneficial to small businesses, which have employees working in multiple cities since the networks are typically quite broad. This allows for more simplified health insurance management than in an HMO or PPO.
POS health insurance policies do not prohibit clients from choosing providers outside of the network, or PCPs, from referring to them. However, if an outside provider is used, a deductible will likely apply, and insurance claims forms must be filled out. The level of coverage for out-of-network care will vary from plan to plan. A POS health care plan does not only cover simple doctor's visits, but also has allowances for testing, in and outpatient care, and hospital stays. Additionally, POS plans will often focus on preventative medicine and offer access and discounts to health clubs
POS health plans have increased in popularity in recent years as both individual consumers and small businesses have sought to combine the freedom offered by a PPO plan with the lower cost of an HMO. With their ability to provide a wider array of services by using a PCP as a gateway, the POS plan strikes a balance between accessibility and reliability, which can be sadly lacking in either of the other traditional plans. With a reasonable monthly payment and low co-insurance for providers within the network, POS health care systems can be a viable and balanced alternative.
