Point of service plans (POS) are sometimes called an ‘open ended HMO’ or an ‘open ended PPO’. This is because a point of service plan offers an approved network of medical care facilities and physicians for their policy holder’s to choose from just like HMOs and PPOs.

How Are Point of Service Plans Different from HMOs or PPOs?

A major difference is that point of service plans allow for their policy holder’s to receive their medical care outside of the network, though use of facilities and physicians within the network is encouraged.

Based upon the idea that medical costs may be offered at a lower cost in exchange for limited choices in medical care facilities and physicians, point of service plans have several variances from similar plan types. For example, newly enrolled policy holders of a point of service plan are required to choose a primary care doctor to keep tabs on their health. This doctor becomes the new policy holder’s point of service and is chosen from the list of pre-approved doctors in the provider’s approved medical care network.

How Are Referrals Handled?

The point of service doctor may refer the policy holder to doctors not included in the network. However, the claim will not be covered in its entirety as it would have been had procedures and appointments been performed by a health care facility within the approved network.

To encourage policy holders to choose facilities and physicians from within the approved network, all paper work for doctor visits within the network are completed for the policy holder, as a courtesy. For medical care visits outside of the network, paper work is expected to be completed by the policy holder. Full documentation of bills, prescriptions, and receipts are required.