Point-of-service (POS) health insurance may not be as familiar as more common plans like HMO and PPO. However, it does offer a plethora of advantages to members. POS health insurance combines several elements from both HMO and PPO plans. Similar to HMO plans, a member is required to choose a primary care physician and seek referrals to network specialists. Like PPO insurance, members have the choice to receive care from non-network providers but may face larger out-of-pocket costs. Before meeting with an insurance broker, consider the pros and cons of POS health insurance.
Pros of POS Health Insurance
POS health insurance is essentially a hybrid of a health management organization (HMO) and preferred provider organization (PPO). With a POS plan, members have the freedom to visit physicians that are out-of-network which allows ample opportunity to receive the medical attention they need with a provider they are comfortable with. As a POS plan is similar to an HMO with out-of-network benefits, members can see any specialist. This flexibility can be highly useful for certain people, such as members who frequently use outpatient medical services, such as physical therapy or counseling.
Other major advantages of choosing POS health insurance from an insurance broker are the low co-pays and zero deductibles. With a POS plan, you will typically have no deductible and the co-payments often range from $10 to $20 for regular office visits with in-network medical providers or facilities. On average, premium costs of a POS health insurance policy are nearly one half of the costs associated with PPO plans. Without a deductible, any out-of-pocket costs are also lowered. The breakdown of cost under a POS plan is similar to other types of managed plans but typically less costly than PPO.
Coverage flexibility is one of the biggest perks of having POS health insurance. POS plans often offer a better combination of in-network and out-of-network benefits than other options like HMO. While you can expect to pay higher out-of-network fees compared to in-network fees, members have wider access to health providers and specialists. POS health insurance benefits are also not limited to local healthcare providers. Unlike PPO plans that restrict benefits to in-network providers within a certain coverage territory or state, POS do not have these local restrictions.
Cons of POS Health Insurance
While POS health insurance can be highly beneficial to some individuals, it may not be as favorable to others. As one of the biggest advantages of a POS plan is the ability to see a broad range of healthcare specialists, individuals who rarely or never need to see a specialist may not get as much value from this plan. Most POS plans also require a referral from your primary care physician. Many people find the process of getting a referral complex and time-consuming. For this reason, some individuals may prefer a plan like PPO which allows you to see any in-network healthcare provider, including specialists, without a referral.
Another major downfall of POS health insurance is the amount of paperwork that members often face. If a member chooses to see an out-of-network healthcare provider, they will have to pay the provider’s fees upfront, which is not always possible due to financial restraints. The member must then file a claim for reimbursement and wait for a decision from the insurance company. If you fail to get a referral from your primary care provider your services may not be covered or be only partially covered. The cost of out-of-network providers can also be high. Members can expect to pay upwards of 30 to 40 percent of the bill out-of-pocket.
Other Insurance Plan Options
POS health insurance is not the right choice for everyone. Fortunately, there are other excellent options you can learn more about from your insurance broker. Preferred Provider Organization (PPO) is one of the most popular plan options. Just like POS and HMO, POS offers a network of healthcare providers that you can use for your medical care. However, PPO provides more flexibility than the other options as this plan allows members the freedom to receive care from any provider in or out of their network.
Health Maintenance Organization (HMO) is another popular option available from your insurance broker. With an HMO plan, members have their own network of healthcare providers and facilities that have agreed to accept payment for services at a certain level. What sets HMO plans apart from other options is that they usually offer lower monthly premiums and have lower copays and coinsurance. If you simply need basic medical care, such as immunizations or the occasional checkup, HMO health insurance offers affordable coverage. The biggest disadvantage of HMO plans is that they do not cover any out-of-network care, except in the event of a true emergency.
When choosing between these health insurance plans, consider your medical needs, plan benefits, and income. PPO plans tend to be more flexible and provide greater coverage. However, PPO health insurance typically comes with a deductible and higher cost. In comparison, HMO plans tend to be more affordable. However, members are usually met with more restrictions and less coverage. In addition to medical coverage, both HMO and PPO health insurance plans may also cover dental and vision coverage. However, additional dental and vision coverage will likely come at a higher price point.
Request a Consultation with BBG
As a business owner, you may be comparing your options for health insurance. While POS plans can offer numerous benefits to your employees, you should also consider what benefits other health plans like HMO and PPO can provide. At the Business Benefits Group in Fairfax, VA, we offer professional benefits consulting services to organizations of all sizes. As you work hard to attract new talent and maintain a successful workforce, it is important to consider which benefits will help your business grow long-term. Offering an enticing employee benefits package with health insurance is a sure-fire way to motivate your employees. Schedule a consultation today to learn more about your health insurance options.