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How A POS Health Insurance Plan Works

How A POS Health Insurance Plan Works


A POS health insurance plan is a hybrid of an HMO type plan and a Fee-For-Service (Indemnity) plan. The plan we describe is a pure POS plan. Any particular plan likely includes additional features.

Like an HMO, you choose a primary care physician (PCP) from the directory of doctors in the plan's network.  The PCP coordinates all of your medical care. If you follow the plan's rules, including what doctor to see and when, what drugs to take, and what treatment to receive and where, your care is covered in full, except for a small co-pay which you pay.

There may or may not be a gatekeeper you have to speak with before accessing services.

Unlike an HMO, you have a choice at the "Point of service" -- at the time you need medical care -- whether you want to stay within the guidelines of the plan, or whether you want to go outside those guidelines (as if you were in a Fee-For-Service (Indemnity) Plan or a PPO.) If you do go outside the network, generally:

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