A point-of-service (POS) plan combines features of an HMO and a PPO. Which statement correctly describes a POS plan?
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Answer & full 3-part explanation (select an option above, or peek)
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.