POS Plans in Michigan
A POS plan is a category of managed care health insurance that combines elements of both HMOs and PPOs. Essentially, it is a kind of HMO that permits choice of doctors. The insured has a choice of who gives medical care, and he also pays at the point of service (POS) if the care is out-of-network.
In a POS plan, the patient is encouraged to use in-network providers, and may have a primary physician in the group. However, if a doctor outside the network is used, the plan will reimburse a fraction of the costs - unlike a true HMO, which will only pay for services within the network. Costs are reduced through the discounts available within the network.
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Advantages of a Point of Service Plan:
- Out-of-pocket costs are higher than for a true HMO, but less than for a PPO if network doctors are used.
- Individuals in a family may choose to have different primary care doctors
- Expenses can be substantially lowered by using the preferred provider list and choosing a primary care physician
- There is freedom to choose a specialist without a referral, but the out-of-pocket costs may be greater than with a referral.
- Preventive care is emphasized.
Disadvantages of a Point of Service Plan:
- Out-of-pocket expenses are higher than for an HMO.
- If you choose to receive out-of-network care, you may need to pay up-front and then file a claim. In-network care usually does not require filing claim forms.
- Pre-certification is required of all hospitalizations and most elective treatments
Point of Service Plan (POS) Plan Details
The focus of a POS is to cut costs by managing care and by encouraging use of a select group of providers that will give deep discounts to the insured. The governing board of the POS decides which treatments are eligible under the plan. POS plans offer preventive care coverage and emphasize staying well rather than getting well. POS plans have more flexibility than the traditional HMO. These plans also allow patients to choose their providers and to change doctors at will. A percentage of out-of-network expenses is covered. Some POS plans have deductibles while, in other plans, the patient pays a co-pay for each doctor visit. Premiums will vary depending on the size of the deductible or co-pay.
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