9.7 Point of Service (POS)

A Point-of-Service (POS) plan combines features of both Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). Under this arrangement, members may decide at the time services are needed (the point of service) which type of coverage they wish to use.

When subscribers choose to receive care within the network, the plan functions similarly to an HMO. In this case, a Primary Care Physician (PCP), also known as a gatekeeper, coordinates the subscriber's care, and referrals are typically required before visiting a specialist.

If the subscriber chooses to receive care from an out-of-network provider, the plan operates more like an indemnity or PPO-style arrangement. In this situation, the subscriber is responsible for higher out-of-pocket costs, and the provider is generally paid on a fee-for-service basis.

Any Provider	Limited Choice
These plans provide greater flexibility, allowing the insured or subscriber to choose any health care provider and still receive benefits.	In contrast, some health plans limit coverage to a select group of providers who have been pre-approved by the insurer or service organization. These participating providers typically agree to accept reduced or negotiated fees in exchange for inclusion in the network and access to plan members.