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POS Insurance Plan

What is a POS Insurance Plan?

A POS Insurance Plan is an insurance plan that allows the insured person to choose providers or specialists with the POS plan's network s referred by their primary care physician, or to self-refer to a provider outside the network. The insured person will receive the highest level of benefits if it uses providers inside the network. With POS health insurance you have greater freedom, but at a higher cost.

A POS insurance plan is also called a point of service insurance plan.

Enrolling into a POS Plan

When you enroll in a POS insurance plan, you are required to choose a primary care physician to monitor your health care. The primary care physician must be chosen from within the health care network. The primary care physician becomes your "point of service".

For medical visits within the health care network, paperwork is completed for you. If you choose to go outside the network, it is your responsibility to fill out the forms, send bills in for payment, and keep an accurate account of health care receipts.

What happens if the doctor refers a person with POS Insurance to a doctor out of the network?

If a doctor refers a patient out of the network, usually the plan pays all or most of the bill. If a POS member self-refers to doctors or specialists outside the network, they will have to pay a predetermined amount of coinsurance.

Questions to ask your POS health insurance provider include:

  • How many physicians are in the network, and where are they located?
  • How many hospitals are in the network and where are they located?
  • What is the referral process?
  • How much is the monthly fee?
  • What are the steps to file a grievance?
  • Can you cancel your insurance if you move to a location not covered by their network?

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