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When you are determining which health care benefits are best to offer to your employees, there are a few options to choose from. Over the course of the next few weeks, we are going to explore the advantages and disadvantages of each medical benefits solution to help you provide the best group health benefits, meeting both the needs of your organization and those of your employees.
Today, we are exploring the advantages and disadvantages of POS insurance.
What is a POS?
A Point-of-Service plan is a managed care plan that is a hybrid of HMO and PPO plans. Similar to an HMO plan, participants designate an in-network physician to be their primary care provider, however like a PPO plan, the participants may also go outside of the provider network for health care services.
How a POS works
As stated above, POS plans combine elements of HMO and PPO plans, requiring participants to designate a primary care physician and obtaining referrals to network specialists as needed. Depending on the plan design, services rendered by a primary care physician are typically not subject to a deductible and preventive care benefits are typically included. And, like a PPO plan, participants can choose to receive care from non-network providers, but this comes at a greater out-of-pocket expense and may require co-payments, coinsurance and an annual deductible.
Advantages of a POS plan
With a POS plan, participants can go out of network easily, allowing visits to any specialist, also benefiting people who use outpatient medical services. There is also greater geographic flexibility, as travelers can visit doctors anywhere and still obtain medical coverage. This is an excellent perk for those who live in rural areas as they may have fewer choices with an HMO in small towns.
Disadvantages of a POS plan
Deductibles can be costly for POS plans if participants choose to use out-of-network providers. A small copay may be required to see a doctor, but when participants use out-of-network providers, a high annual deductible may have to be satisfied first.
Like PPOs, POS plans also come with high quantities of paperwork for out-of-network care. Doctor fees may have to be paid upfront, in full and participants must file their own insurance claims. Reimbursements can also take months to be filled.