POS health plan? Sorry, I have to do some ironing.

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POS health plan? Sorry, I have to do some ironing.

It’s confusing, it can be pricey, and there are several household chores you’d rather do, than deal with it… It’s your health benefits. But don’t worry, you can do this. Consider this your health benefits 101.

What is a POS health plan?

It is one type of health insurance plan. “POS” stands for “Point of Service,” meaning that you can choose a health care provider right when making an appointment. Depending on your health care needs, the POS plan allows you to select an “in-network” provider or “out-of-network” provider of your choice.

For example, you might have a primary care doctor who is in-network, but an out-of-network chiropractor. POS health plans usually cover your care from in-network doctors or health care providers at a lower cost than out-of-network care.

Your employer may offer this plan so that members who do not live in the same area can have access to care they need. It can also be helpful for employees that need out-of-network care. A POS plan is commonly available as an option alongside an HMO (health maintenance organization) plan from the same insurance company; as “dual choice” options.

 

Illustration of Middle of the Road, between several Irons

Middle-of-the-road

The POS health plan is like a “happy medium” between a PPO (preferred provider organization) and an HMO.  Sometimes a POS plan can have a lower premium cost than a PPO, because the POS uses an HMO network associated with that insurance company.

A nice thing about a POS plan is that it may cover more towards out-of-network health care service if the HMO or in-network primary care physician makes a referral for the service.  You should consider getting a referral for an out-of-network provider before getting treatment.

 

Benefits 101: little child getting medical care from her POS health care provider.

Networks

A POS health plan utilizes an associated HMO network from the same insurance company.
With these in-network services, you’ll pay much less in out-of-pocket costs. This is meant to encourage choosing in-network providers whenever possible.  

The POS will cover a limited amount of out-of-network care, but usually for very high costs out-of-pocket (including the deductible).

Want provider flexibility?

A POS provides coverage nationwide and you don’t have to live in any specific geographic area for the coverage. The POS might be right for you if you frequently travel or live outside of other available health plans’ service areas.  

A directory of in-network providers is usually available from your insurance company. However, it is important to always directly confirm with a provider that they are in your network before receiving services from that provider.

Preauthorization and Referrals 

Like HMO plans, POS plans often require you to get a referral from your primary care physician for treatment from a specialist doctor.

In addition, be sure to read the insurance provider’s preauthorization rules carefully. Certain procedures must be “okayed” before getting the procedure.

Other Types of Plans

When it is time to enroll in a health insurance benefit plan, there may be several different options from your employer. HMO plans, PPO plans, and POS plans are some of the types of health coverage plans that may be available to you through your employer’s benefits. Each type of plan may vary in cost, regions of coverage, and network providers.

It’s up to everyone to elect the coverage that is best for them and their situation. When determining which health plan is right for you, there are a few factors to take into account:

  • Geographic location
  • Personal budget
  • Dependent family members
  • Type of health care services needed
  • Frequency of services needed

v two young people looking at tablet to examine benefit plan options including POS, HMO, and PPO health plans as part Benefits 101

 

Information Overload

Choosing a health plan can be tricky. There can be a lot of information to deal with. But, the more general concepts that you know, the better equipped you will be. You can make an educated choice!

Recognizing your needs and a bit of prep will lead you down the right path. This will empower you to proceed confidently when it is time to enroll in benefits, instead of being overwhelmed.

Even if your employer provides only one option, carefully reading the information in the plan documents will help you use the health plan wisely.


But wait, there’s more. This is a general description of a POS health plan, but that isn’t all of it. Check your Summary Plan Description (SPD) from your health insurance company. It contains what you need to know about the specific rules of your plan.

If you want to know rules about any of our Employee Benefits Corporation plans, please check the specific Plan's Summary Plan Description (SPD) by logging in at www.ebcflex.com to access it. There you will also find other helpful information that explains the specific rules for your BESTflex Plan health care flexible spending account, EBC HRA, or SimplyHSA: benefits that give you a way to save pre-tax money on your healthcare expenses.

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