A point-of-service (POS) plan combines features of an HMO and a PPO. Which statement correctly describes a POS plan?

Why A is correct

A POS plan is the hybrid of the managed care models: like an HMO it requires the member to select a primary care physician who coordinates care and issues referrals, and like a PPO it permits care outside the network — though out-of-network care typically costs more and may require a referral. The POS design is popular with employers because it preserves cost discipline through the gatekeeper while giving members flexibility at the point of service. This blend of gatekeeper coordination with out-of-network flexibility is the defining POS feature that the A&H exam contrasts against pure HMO, PPO, and EPO structures, so the correct answer must reflect both halves of the model.

Why the other options are wrong

• B) 'Coverage limited to network providers only' describes an EPO, not a POS plan. A POS plan does permit out-of-network care, albeit at a reduced benefit level, so excluding it entirely misstates the model and confuses the two plan types.
• C) POS plans generally do provide some out-of-network coverage, often with a referral requirement; total denial of out-of-network care is the HMO or EPO pattern, not the POS pattern, so this answer overstates the restriction.
• D) No managed care plan reimburses all providers at 100% with zero cost-sharing; POS members still face deductibles, copays, and coinsurance just like members of other plan types.

Memory hook

POS = PCP gatekeeper like an HMO, plus a PPO-style escape hatch to out-of-network care — at a price.

Why B is correct

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.

Why the other options are wrong

• A) Going out of network without a referral is a PPO feature; a POS plan keeps the gatekeeper requirement even when the member leaves the network.
• C) A member does not have to leave the POS plan to use out-of-network benefits; out-of-network access with a referral is built into the POS design.
• D) CMS is the federal Medicare agency and plays no role in authorizing a privately insured POS member's specialist visit.

Memory hook

POS = PPO flexibility plus HMO gatekeeper. Want out-of-network care? Get the PCP's referral first.