Question

36. Point-of-service (POS) plans are similar to those offered by planned provider organizations (PPOs), yet they allow for consumers to select non-plan providers when seeking medical care. Those who choose non-plan providers, however, will be expected to: Select one:

a. Contribute a large percentage of the copayment

b. Excuse themselves from the POS plan after medical services have been received

c. Pay large deductibles on their medical bills before the insurer picks up the bill

d. Pay higher premiums after receiving services.

Answer 1

Answer: a. Contribute a large percentage of the copayment.

Point of service (POS) is the mixture of HMO( Health maintenance organisation) and PPO(Planned provider organisation) Means POS give the benefits of in network and out of network provider. In network providers are those who (doctor,hospital or health facilities) accepts the health plan and on the other hand, out of network (or nonplan providers) are those who doesn't accept the health plan. There are most of similarities present in POS and PPO . Main difference is that in PPO there is no need of referral but in POS there is a need of referral from primary care physician ( also known as PCP).

Along with that, with POS if you go to non plan providers (or out of network providers) you have to contribute a large percentage of copayment in comparison to in network providers. For, if it is an in network you may have to pay 40% of the copayment but when out of network providers you may have to pay 70% of the copayment.

2nd options are incorrect as you can not excuse themselves after the medical service received.

3rd option is incorrect as you have to pay more deductible with respect to in network providers irrespective of when the insurer picks up the bill.

4th option is incorrect as the insurer will not pay higher premiums after receiving services as the nonplan provider doesn't accept their plan.