Point-of-Service (POS) Plan

Obtain a referral from the primary care physician (gatekeeper) before seeing the out-of-network specialist — A POS plan is a managed care hybrid: like an HMO it requires the member to select a primary care physician who acts as a gatekeeper, and like a PPO it allows care outside the network. The tradeoff is that using an out-of-network specialist ordinarily requires a referral from the primary care physician, and out-of-network care carries higher cost-sharing. Because the gatekeeper-referral mechanism is preserved, the member must obtain that referral before the out-of-network visit.

National insurance concept

Members select a primary care physician, in-network specialty care generally requires a referral, and members may also obtain care outside the network at a higher out-of-pocket cost — A point-of-service (POS) plan is the hybrid of HMO and PPO features: the member selects a primary care physician who serves as the gatekeeper for in-network care (specialists generally require a referral), but unlike a pure HMO, the member may go outside the network without a referral and receive coverage at a higher level of cost-sharing, such as a separate deductible and higher coinsurance. The exam tests POS as the plan type that keeps the HMO gatekeeper for in-network care while adding limited out-of-network flexibility at the member's expense.

National insurance concept