How Does A Point Of Service (POS) Health Insurance Plan Work?

Is A POS Health Insurance Right For Your Needs?

With the cost of healthcare rising, many people are looking into ways to save money on their medical expenses. One great way to do this is to get a point-of-service (POS) health insurance plan. But what is POS health insurance, and how does it work?

A POS health insurance plan is a type of insurance that allows you to pay for your healthcare costs in monthly installments. It means you don’t have to worry about unexpected medical bills because you can take care of them all at once. Plus, these plans usually offer lower premiums than other types of health insurance.

A POS plan might be good for you if you’re looking for Rapid Valley health insurance, but it all depends on your needs. Read below to learn more.

Discussing POS Health Insurance

What Exactly Is a Point Of Service (POS) Health Insurance Plan?

A point-of-service (POS) is a type of health insurance plan offered by employers. This health insurance plan allows employees to purchase coverage through their employer instead of an individual or family policy. 

These plans are popular among businesses because they provide numerous benefits such as lower overhead costs, simplified administration, and tax-effective employee benefits.

These plans combine elements from a PPO and HMO, making them versatile and cost-efficient.

With a POS plan, you can obtain special care from an out-of-network or in-network provider. However, you pay less for in-network options. 

Since you must coordinate your treatment properly, most POS plans ask you to work with a primary care provider. This way, you can get a referral if you need a specialist. This is similar to an HMO plan. 

Is a PPO Or HMO Plan Right For Me?

There are advantages and disadvantages to each type of health insurance plan, so you’ll want to carefully discuss the details of each type of plan with your South Dakota health insurance agents.

Many people appreciate an HMO because they never need to pay more than a predetermined copay and know in advance exactly how much an appointment will cost. There are always exceptions to this rule, so be sure to understand how your coverage works, which services are covered, and who is in your network. With an HMO, you’ll probably have access to a smaller health network, but the copays tend to be less expensive.

Other people prefer a PPO because they want the freedom to choose providers and visit specialists. You’ll likely have access to larger networks and more providers. However, the cost of each appointment can vary; your deductible and copays will probably be a lot higher than an HMO. In most cases, you’ll need to pay your deductible before the plan will cover additional healthcare services and costs.

As you decide whether an HMO or PPO is best for you, consult with an experienced Rapid Valley health insurance agency. Consider your lifestyle, healthcare needs, financial situation, proximity to covered emergency services, and your personal approach to your healthcare as you make your decision. Either way, your agents are ready to help you explore your options as you determine which type of plan will provide the best coverage for your needs.

How Does a POS Healthcare Insurance Work?

POS plans have agreements with a team of doctors, specialists, and medical facilities. Network providers agree to be paid at a reduced rate for the services they offer to plan members. Once you visit an in-network contractor, your Colonial Pine insurance provider will pay the majority of the bill once you have fulfilled your deductible.

You can seek treatment outside of your network with a POS plan. The drawback is that your insurance company only covers a small portion of the expense. POS plans allow you to choose between in-network and out-of-network providers, but you will pay less if you choose an in-network doctor or hospital.

Emergency care is the only exception to this rule. Whether the facility is in-network or out-of-network, your POS plan will offer the highest level of coverage if you need to go to the emergency room or an urgent care center.

Before receiving specialized treatment through a POS plan, you must first see your primary care provider and obtain a referral. Dermatologists, PTs, and cardiologists are some examples of specialists. When you first enroll in a health plan, you’re usually required to choose a primary care doctor from the plan’s network.

What Is the Price Of A POS Health Insurance Plan?

On the ACA marketplace, the monthly average cost of a POS plan is $505 for 30-year-olds, $568 for 40-year-olds, and $794 for 50-year-olds. Nonetheless, these prices vary depending on age, location, and plan design. 

Your South Dakota insurance provider will give you more details about the cost,  but make sure to ask all the necessary questions so you don’t have doubts later.

Furthermore, the cost of your plan is determined by where you obtain coverage. For example, individual health insurance plans purchased directly from an insurance company are more expensive than ACA marketplace plans. You can expect to pay a much lower rate through employer-sponsored plans.

If you qualify, you can also get a subsidized ACA marketplace plan. The Affordable Care Act (ACA) includes subsidies and premium tax credits that can reduce the cost of health insurance for people whose household income is less than 400% of the federal poverty level.

Pros Of POS Health Insurance

POS health insurance plans have numerous advantages. Before purchasing this type of health insurance, you must weigh the benefits.

  • Out-of-network treatment: You can see a provider or specialist who is not part of the plan’s network. It gives you more options for doctors and hospitals.
  • Hybrid plans: POS plans combine aspects of PPO and HMO.
  • Low costs: POS plans frequently have lower out-of-pocket costs than other health plans. Some plans may have no deductible.

Always talk to your Rapid Valley health insurance provider about the benefits of this plan before purchasing it. 

Get The Right Plan At The Right Moment

South Dakota Health & Life Insurance is ready to help you decide the best plan! Our experienced insurance agents will guide you to set up and get the best coverage and policies. Contact us now to get started! 


South Dakota Health Insurance
5040 Saturn Dr,
Rapid City, SD 57703

Tel: 605-653-3824