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What is a Point-of-Service (POS) plan?

A POS plan offers all the benefits of an HMO, with the freedom to access any physician or hospital, in or out of the network. With a POS plan, your PCP coordinates your care, and while referrals aren’t required, you’ll pay less when you use a referral to see an in-network doctor or hospital and more if you choose an out-of-network doctor or hospital.

Another type of POS plan is called POS Non-Gated (NG). With a POS NG plan, you do not need to choose a primary care provider; you have the freedom to see any specialist you wish, in- or out-of-network; and you do not need a referral for specialty care.

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POS out-of-pocket costs

In addition to a monthly premium, POS members will also have out-of-pocket costs. These payments are often called cost-sharing and come in the following types:

Coinsurance: This is the percentage the member pays for some covered services. If the coinsurance is 20 percent, the health insurance company will pay 80 percent of the cost of covered services, and the member will pay the remaining 20 percent. The amount the member pays is typically not based on the full retail price of the service. It is based on a discounted rate negotiated by the insurance company with heath care providers like doctors and hospitals.

Copay: The set amount members pay for a covered health care service. For example, the copay to see a doctor could be $20, while the copay for an emergency room visit could be $100.

Deductible: The amount a member pays each year before the health plan starts to share the costs. For example, if the plan has a $1,000 deductible, the member pays the first $1,000 of the costs for the services received. Once the deductible has been met, the insurance will pay for some or all health care services, depending on the health plan.

Out-of-pocket maximum: An out-of-pocket maximum is the most a member will have to pay for health care expenses during a plan period (usually a year) for covered services received from providers that participate in the plan’s network. No matter what, a member will not pay more than this maximum amount in a given year. Any care received for covered services after the out-of-pocket maximum has been met will be covered 100 percent by the insurance company.

What POS plans are available from AmeriHealth?

Currently, AmeriHealth does not offer POS plans to individuals and families. They are only available through our employer groups. If your employer offers AmeriHealth coverage, talk to your benefits administrator to learn more about your plan options.