Carney Cargill, Inc. 375 NE Ericksen Avenue Bainbridge Island, WA 98110 Phone: 206-842-8987 Health Life Disability Long-term Care Employee Benefits

Learning Center

 Home About Us Apply Online Contact Us

Point-of-Service (POS) Plan

Many HMOs offer plan members the option to self-direct care, as one would under an indemnity or PPO plan, rather than get referrals from primary care physicians. Carney Cargill, Inc. 375 NE Ericksen Avenue Bainbridge Island, WA 98110 Phone: 206-842-8987An HMO with this opt-out provision is known as a point-of-service (POS) plan. How the plan functions (i.e., like an HMO or like an indemnity plan) depends on whether individual plan members use their primary care physician or self direct their care at the "point of service."

To illustrate this point, this is how these plans typically work. When medical care is needed, the individual plan member essentially has two or three choices, depending on the particular health plan. The plan member must choose a primary care physician in order to receive the most comprehensive coverage. He/she can choose to go through his or her primary care physician, in which case services will be covered under HMO guidelines (i.e., usually a co-payment will be required). If the plan member chooses to obtain services from a provider outside of the network, the services will be reimbursed according to out-of-network rules (i.e., usually a deductible and higher coinsurance charge will be required). Because people who belong to POS plans are responsible for deciding how to access care within the various options, it is important that they understand the financial implications of these choices.

Related topics:

» Why do you need health insurance?
» Where does one get coverage?
» What plans am I eligible for?
» Fee-For-Service (Indemnity Plan)
» Health Maintenance Organizations (HMOs)
» Preferred Provider Organizations (PPOs)
» Health Savings Accounts (HSAs)
» Dental Plans
» Vision Plans