What is Point of Service (POS) Health Insurance?

What is a POS health plan?

Point of service (POS) health insurance is a plan that blends the care coordination of HMO (Health Maintenance Organization) plans with the flexibility of PPO (Preferred Provider Organization) plans. 

With POS plans, you usually choose an in-network PCP to manage care, but you can see out-of-network providers at a higher cost. Your level of coverage will be better when you stay in-network.

Depending on your point of service health plan design, you're often required to get referrals from your PCP.

What does “point of service” mean?

The term "point of service" refers to where and from what provider you receive services. Your coverage varies depending on whether you've:

1. Seen a provider who’s in- or out-of-network.
2. Received a referral, if required by your plan.

How do point of service plans work?

POS plans start with a primary doctor who helps guide your care.

Like an HMO, you choose a PCP first to coordinate care. Like a PPO, you can choose to see doctors outside the network but at a higher cost.

Comparing POS vs. HMO vs. PPO Plans

What are the pros and cons of POS insurance?

Pros of POS

• Costs are typically lower for in-network providers.
• Ability to see out-of-network providers.
• Paperwork is usually done for you for in-network care. 

Cons of POS

• Typically need referrals to see specialists.
• Out-of-network care is usually more expensive.
• Responsible for paperwork for out-of-network care and services. 

How to Use a POS Plan, Step-by-Step

1. Choose a PCP (in-network, if possible).
2. Confirm if referrals are required.
3. Check the network status of providers before your appointments.
4. Get any prior authorizations, if needed.
5. Keep receipts and submit claims for out‑of‑network care.

Are POS insurance plans all the same?

No. This article is a high-level look at traditional POS health plans. Depending on the plan design and the insurance provider, the features of a POS plan may differ, as well as plan name.

Is a POS plan right for me?

POS insurance works best if you’re willing to follow the terms of this type of health plan. If you’re comfortable selecting a PCP to manage your care, this plan may be right for you.

Remember, even though a POS plan might have an overall lower cost, you may pay higher costs if you need to see a provider that’s outside your plan’s network. It’s worth checking to make sure the providers you normally see are in-network for the plan you’re choosing.

POS Frequently Asked Questions (FAQs)

What if I have an emergency out‑of‑network?

Emergency care is covered at in‑network levels under federal rules.¹

Can I see an OBGYN without a referral?

Many POS plans allow you to do this, but always check your plan details.

What if I skip a required referral?

Your visit may be covered at a lower level (or not at all).

How do I submit out‑of‑network claims?

You usually send itemized medical bills and receipts to your insurer.