What “Point-of-Service” Type of Health Plans Mean to Specialists:

Typically, patients in a “Point-of-Service” type of health plan have greater choice of providers to choose from than if they were just in a HMO and these patients can choose to go to a specialist of their choice, as compared to having to stay within the network of contracted providers of the HMO

Many Managed Care Organizations (MCOs) plans created a product to offer to its Members called “Point-of Service”. Some states require health care plans to offer a Point-of-Service option to its enrollees. “Point-of-Service” is where the members of that plan can choose to go outside of the normal plan and those members pay more.

POINT OF SERVICE (POS)

A type of health plan allowing the covered person to choose to receive a service from a participating or a non-participating provider, with different benefit levels associated with the use of participating providers.  Essentially, Point- of-service is where the members of that plan can choose to go outside of the normal plan and those members pay more.  Point-of-Service can be provided in several ways:  an HMO may allow members to obtain limited services from non-participating providers:

  • an HMO may provide non-participating benefits through a supplemental major medical policy;
  • a PPO may be used to provide both participating and non-participating levels of coverage and access;
  • various combinations of the above may be used.

One way to think of Point-of-Service type of plans is to think of a patient who has health care insurance coverage at a cost more expensive than a HMO plan and a little bit more expensive than a PPO plan and this additional cost allows the patient more choice and access to participating and non-participating providers.  The patient can choose at the time of service to go to a participating provider, i.e. a provider contracted with the health plan to be part of the network of participating providers or pay even more money and go to a non-participating provider, i.e. a provider not contracted with the health plan and is not part of the network of participating providers.

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