IV.

Point-of-Service Plans

Point-of-service (POS) plans give participants the opportunity to choose whether to receive treatment within the plan’s network of healthcare providers or outside the network at the time they receive medical treatment. In this way the point-of-service plan combines aspects of a traditional health insurance policy with aspects of an HMO or PPO. If healthcare services are provided by a physician who is a member of the HMO or PPO network, then benefits are the same as if the person were an HMO or PPO member. If healthcare services are delivered by a provider who is not on the preferred list, coverage is the same as a traditional health insurance policy, which means that the patient will share more of the costs. The member also assumes responsibility for paying the cost of services received. Once paid, bills are submitted to the plan for reimbursement. The patient must pay a deductible and usually pays a fixed percentage of the charges (typically 20 percent) with the traditional health plan covering the remainder.