What is Point Of Service?

If you have coverage under a point-of-service plan, you can pick an out-of-network provider, and the plan will reimburse some of the charges (typically based on reasonable and customary amounts and the specifics of the plan in terms of the percentage of amounts the plan will pay). Remember that out-of-network providers can still send you a balance bill—with the out-of-network deductible, copay, or coinsurance that your health insurance plans establish—there aren’t any signed contracts with your insurer and thus you haven't agreed to accept your insurer's reasonable and customary amounts as payment in full.

POS plans can set their own rules regarding referrals from primary care providers. Some plans require them, and others do not. Plans are plans devised with health maintenance and health care as their main motives. It has the features of both HMOs and PPOs. The insured is given two options when it comes to this insurance plan: she or he can have a primary care physician go to him and get the medication done by paying the doctor the co-payment (service fee).

 The second option gives individuals the freedom to go to any doctor or hospital they like, irrespective of its inclusion in the company network. However, the individual will have to pay part of the bill (20–30% or more, depending on the plan). POS plans require individuals to pay deductibles apart from the above-mentioned fee. Deductibles are to be paid before the insurance period starts for reimbursement of medical expenses.