What is a Point of Service Plan?

A Point of Service (POS) plan is a hybrid health insurance model that combines features of HMOs and PPOs. Like an HMO, you choose a primary care physician who coordinates your care and provides referrals for specialists. However, like a PPO, you can also see out-of-network providers at a higher cost-sharing level. POS plans offer more flexibility than HMOs while maintaining some cost control through the primary care coordination.

Why point of service plans matter

• Balances cost and flexibility: Provides managed care savings with options for out-of-network access
• Offers tiered benefits: Pays more for in-network care while still covering some out-of-network services
• Maintains care coordination: Uses primary care physician oversight to improve quality and efficiency

How Solace can help

A Solace advocate can help you understand POS plan rules, navigate the referral process, and determine when using out-of-network providers makes financial sense. Advocates can also assist with claims issues when using different levels of the provider network.