What is a POS Plan?

What is a POS Plan?

• A. Blend of PPO flexibility and HMO gatekeeper structure
• B. Less restrictive network with discounted fees and minimal UM
• C. Before care; includes prior authorization
• D. Indemnity plan; least managed care

Answer: (A)

A POS plan is a hybrid managed care arrangement that combines features of an HMO and a PPO. It uses a primary care physician as a gatekeeper to coordinate care and help control costs, like an HMO. At the same time it offers the option to seek care from providers outside the network, similar to a PPO, though with higher out-of-pocket costs. In-network care typically requires referrals for specialists, while out-of-network care comes with greater cost-sharing. This blend gives you the lower costs and coordinated care of an HMO while preserving some flexibility to go outside the network when needed.

A POS plan is a hybrid managed care arrangement that combines features of an HMO and a PPO. It uses a primary care physician as a gatekeeper to coordinate care and help control costs, like an HMO. At the same time it offers the option to seek care from providers outside the network, similar to a PPO, though with higher out-of-pocket costs. In-network care typically requires referrals for specialists, while out-of-network care comes with greater cost-sharing. This blend gives you the lower costs and coordinated care of an HMO while preserving some flexibility to go outside the network when needed.