What Is a Point-of-Service Plan (POS)?

A point-of-service plan (POS) is a form of managed care program that lets you choose a primary care physician from a list of in-network providers while also giving you the freedom to seek treatment from out-of-network health care providers. You’re covered when you seek care from out-of-network health care providers but at reduced benefit levels, for example, 60% or 70% of in-plan coverage. You’re also responsible for filling out and submitting your out-of-network service paperwork to your insurer for reimbursement.

Learn more about a point-of-service plan, how it works, how it differs from other plans, and the pros and cons of this healthcare coverage. 

Definition of a Point-of-Service Plan

A point-of-service plan (POS) is a managed care plan that lets you pay less if you use in-network hospitals, doctors, and health care providers. This plan also gives you the flexibility to see an out-of-network provider at a higher cost or reduced benefit level. 

• Alternate names: Open-ended plan, HMO/PPO hybrid
• Acronym: POS

How a Point-of-Service Plan Works

A POS plan combines features of both HMO and PPO plans. A POS plan works like an HMO because it lets you choose a primary care physician who will coordinate and monitor your health care. You’ll pick a primary care physician from a list of participating providers, and you’ll need a referral from them if you need to seek specialist services. 

Similar to an HMO plan, a POS plan designates a nominal copayment amount for in-network care, usually around $10 per visit or treatment. Also, there’s no deductible for using in-network providers.

Like a PPO, a POS plan lets you seek care from out-of-network providers, but you’ll pay a higher cost than you would incur with an in-network provider and you may have a deductible. In addition, you must also file a claim for reimbursement by your insurer.  With a POS plan, you don’t need pre-approval before receiving emergency care services from out-of-network facilities or providers.

Pros and Cons of a Point-of-Service Plan

Pros Explained

• Network flexibility: By blending aspects of HMOs and PPOs, a POS plan offers more freedom of choice to use in-network providers while obtaining other health care services from out-of-network providers. 
• Lower in-network copays: The in-network copay starts as low as $10 per appointment.
• Zero in-network deductible: There’s typically no deductible for using in-network health care providers. Coverage takes effect from the first dollar you spend, provided it’s within the POS network of providers. 

Cons Explained

• Referrals needed: In a POS plan, you must select a primary care physician who coordinates your medical care. You must consult your physician before seeking care from a specialist.
• Higher out-of-network copays: You are able to see out-of-network providers, but you may need to cover up to 40% of the costs. 
• Out-of-network deductible: Coverage for out-of-network care won’t begin until you meet a specified deductible amount. 

Point-of-Service Plan (POS) vs. Exclusive Provider Organization (EPO)

A point-of-service plan has the characteristics of both HMO and PPO plans, but how does it compare to an exclusive provider organization (EPO) plan?

While a POS plan covers health care costs (or a portion thereof) for both in-network and out-of-network providers, an EPO plan covers only services from hospitals, doctors, or specialists in the plan’s network (except during an emergency). As a result, you don’t need a primary care doctor with an EPO since you can visit any in-network provider. If you choose an out-of-network provider, you will be responsible for all costs.