insurance

Point of Service Plan

A type of health insurance plan that combines features of HMO and PPO plans, requiring you to choose a primary care physician and get referrals for specialists, but allowing you to go outside the network for higher out-of-pocket costs. It offers more flexibility than an HMO while maintaining some cost controls through the referral system.

Example

“Jennifer's point of service plan allows her to see specialists without referrals, but she pays 40% coinsurance instead of the 20% she'd pay with a referral from her primary care doctor.”

Memory Tip

Remember 'POS = Pick Options at Service' - at the point you need service, you pick between lower-cost in-network care or higher-cost flexibility.

Why It Matters

POS plans offer a middle ground for people who want some managed care savings but also want flexibility to see specialists or out-of-network providers when needed. This can be valuable if you have ongoing health conditions requiring specialist care or if you travel frequently and need healthcare access outside your home area.

Common Misconception

People often confuse POS plans with PPO plans, thinking they offer the same level of out-of-network benefits. However, POS plans typically have much higher out-of-network costs and may not cover out-of-network care at all unless you get proper referrals, making them more restrictive than true PPO plans.

In Practice

Your POS plan covers 90% of in-network specialist visits with a referral, 70% without a referral, and 50% for out-of-network specialists. A $200 dermatologist visit would cost you $20 with a referral from your primary doctor, $60 without a referral but staying in-network, or $100 if you go out-of-network. The referral system saves you significant money while maintaining some flexibility.

Etymology

The term emerged in the 1980s healthcare industry, with 'point of service' referring to the moment when you receive care and must decide whether to stay in-network with lower costs or go out-of-network with higher expenses.

Common Misspellings

Point of Service PlanePoint of Sevice PlanPoint of Service PlanPoint of Servise Plan

Related Terms

In-Network Provider coinsurance

More in insurance

Other insurance terms you should know

deductibleThe amount you pay out-of-pocket before your insurance begin…insurance premiumThe amount paid periodically to an insurance company in exch…deductibleThe amount a policyholder must pay out of pocket before insu…copayA fixed amount paid by an insured person at the time of a me…coinsuranceA cost-sharing arrangement where the insured pays a percenta…out-of-pocket maximumThe most an insured person will pay for covered healthcare s…