Which statement correctly describes a point-of-service (POS) health plan?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
A POS plan blends managed care and flexibility: like an HMO it requires members to select a primary care physician who acts as the gatekeeper, yet like a PPO it extends at least partial coverage to out-of-network providers, usually at a higher deductible, coinsurance, or copayment level and frequently upon referral from the primary care physician. This hybrid design is a standard managed care plan type tested under the individual medical expense outline (AH-III.A.1a). The member's cost-sharing is highest for out-of-network care, which is the trade-off for preserving provider choice.
Why the other options are wrong
- B) POS plans do reimburse out-of-network care, but at higher cost-sharing; they are not network-exclusive like an EPO.
- C) POS members must choose a primary care physician; the gatekeeper model applies, though out-of-network care can be obtained.
- D) POS plans maintain a contracted provider network; the no-network structure describes traditional indemnity insurance.
Memory hook
POS = HMO gatekeeper plus an escape hatch: out-of-network care at a higher price.