Point of Service Plans Explained
Because Point-of-Service plans are managed care hybrids similar to HMOs and PPOs, you may want to read up on the latter two before going further. POS plans are rarely avaialble to individual consumers in Illinois, but from time to time different companies will give them a shot to try to lower costs. They do remain a popular group option. BCBSIL's Select Advantage plan is a godd example of the model in Illinois.
Same Managed Care, More Choices
For the most part, POS plans are based on the same managed care principles as HMOs; you're offered lowered medical cost in return for limited choice. Your costs are similar, and you need to choose a network-based physician as your primary healthcare provider. And just like a PPO, POS plans provide access to partial coverage whenever you use out-of-network healthcare services.
BCBSIL offers a derivative of this with their Select Advantage plans which offer a smaller network to choose from in exchange for a reduced premium. this works fine in large metropilitan area like Chicago, but you could be severely restricted in rural area's, so before you sign up for this model of plan be sure to check and see if there are any providers in your area.
By making use of what's called a two levels of benefits system (in plan and out of plan), POSs have become a remarkably popular health insurance option over the last few years. POS plans allow you to choose how, when and where you receive your benefits, giving you a substantial amount of control over your out-of-pocket expenses.
So, What's the Difference?
It's all sounding good, but keep in mind these important differences between POS coverage and other managed care plans:
Advantages of POS Coverage
- You're not limited to HMO in-network providers.
- Your in-network care co-payments are low and there wonęt be a deductible.
- Your annual out-of-pocket costs are limited.
- You'll have the more freedom, especially compared to other HMO's.
- You probably won't need a referral from your primary care doctor if you need emergency or urgent care.
Disadvantages of POS Coverage
- The co-payments for your out-of-network care are higher than average. This is a feature that helps lower premium.
- A deductible is applied to your out-of-network care. This is common for all plans except traditionals.
- You may have problems getting referrals to specialists.
- If you're traveling outside of your network's area or have a dependent living outside the network area, the same rule will be applicable. But, those benefits will cost you more out-of-pocket.
- You're required to select a primary care physician, but you won't be limited to in-network services. You have the option of visiting a specialist or alternate care giver from outside your POS Network.
What About the Cost?
The general cost breakdown of your POS Plan is similar in most respects to other managed care plans. In fact, though more expensive than an HMO, (in the Northeast, Northwest, and Minnesota) your POS coverage could wind up being cheaper than a comparable PPO because your health insurance carrier will be regulating most of your health care services. But, that level of control will work to reduce the cost of your POS Plan.
Be sure to ask as many questions as you need, and if the POS plan you're considering doesn't satisfy you give us a call at 800-391-7469 so we can assist you. | 
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