The POS plan is like a combination of the HMO and PPO plans.
You are required to designate an in-network physician to be your primary health care provider. You may go out-of-network if you choose, but in doing so, you will have to pay most of the cost yourself, unless a primary care physician refers you to that specific doctor. In that instance, the health plan will pay all or most of your bill. Depending on the networks available in your area, a POS plan may be a great choice for your small business, if your employees work in multiple cities with different groups of doctors and hospitals available to them.
The breakdown of cost under a POS plan is similar to that of other managed care plans. It may be slightly less costly than a PPO because the health insurance company will still regulate most of your health care.
For example, to see a health care specialist you must first have a referral from your primary care physician. If the decision were up to you, you might choose an expensive non-network specialist, but your primary care physician (who works within the network) will probably choose a specialist from within that network. These controls reduces the overall cost of a POS health insurance plan.
Your actual costs will consist of the monthly premium and a copayment for health care services covered under the plan and within the POS network.
You’ll also carry a deductible on any non-network care, and after the deductible is met, you’ll still pay a higher percentage of the cost and maybe the difference between what the health care provider charges and what the plan deems to be “reasonable and customary” for the service.