POS Health Plans in Georgia
A POS plan is a type of managed care insurance that combines features of both HMOs and PPOs. It is basically a type of HMO that allows choice of doctors. The patient has a choice of who gives medical care, and he also pays at the point of service (POS) if the care is out-of-network.
In a POS plan, the insured is encouraged to use network providers, and may have a primary physician in the group. However, if a provider outside the network is used, the plan will reimburse a percentage of the costs – unlike a true HMO, which will only pay for services within the group. Costs are reduced through the discounts available within the network.
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Advantages of a Point of Service (POS) Health Plan
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Out-of-pocket expenses are less than those for a PPO if the in-network providers are used
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Family members may choose to see different doctors
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Using the preferred provider list and choosing a primary care physician can substantially lower costs
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There is freedom to choose a specialist without a referral, but the out-of-pocket costs may be greater than with a referral
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There is an emphasis on preventive care
Disadvantages of a Point of Service (POS) Health Plan
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Out-of-pocket costs are greater than the costs for an HMO
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If you receive out-of-network care, you may need to pay up-front and then file a claim (in-network care will usually not require filing claim forms)
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Pre-certification is required of all hospitalizations and most elective treatments
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Point of Service Plan (POS) Health Plan Details
The focus of a POS is to cut costs by managing care and by encouraging use of a select group of providers that will give deep discounts to the insured. The POS decides which treatments are permissible under the plan. POS plans offer preventive care coverage and emphasize staying well rather than getting well.
This type of plan has more flexibility than the traditional HMO, as patients may choose their providers and change doctors at will. Out-of-network expenses are covered to some degree. Some POS plans have deductibles while in other plans, the patient has a co-pay for each doctor visit. Premiums will vary depending on the size of the deductible or co-pay.
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