What Is a Point of Service Plan?

A point of service plan is a type of health insurance plan that individuals can purchase which will provide them with some of the features of an HMO and a PPO. This type of health insurance plan is preferred because in some cases, it can be less expensive than the other two options. Here are a few things to consider about the point of service plan and how it works.

Primary Provider

One of the unique features of this particular type of health insurance plan is that you will have to choose a primary care provider when you get started. This means that you have to choose a doctor from the list of approved professionals. Each one of service plan will have different doctors that they contract with. You will need to find one that is in your area and choose one to monitor your health. Anytime that you need basic healthcare, you will go to this doctor. The doctor will report information to the point of service healthcare plan. By using this strategy, the insurance company can keep track of how healthy you are which will potentially help them avoid bigger bills in the future.


As with other types of health insurance, the point of service plan provides you with a network of healthcare providers and doctors. One of the differences between this type of plan and other plans is that the network tends to be smaller. You only have a few hospitals, medical clinics, and doctors that you can choose from in your area. Typically, every area will be represented with at least a few options, but you will have fewer options than if you had chosen a PPO or an HMO.

Out of Network

Another difference with this type of plan is that you can go to medical facilities that are out of your network. The differences in coverage are not nearly as drastic as they are with HMOs and PPOs. While the insurance company will encourage you to go to a medical facility that is in network, they will not penalize you greatly if you have to go somewhere else. 


One of the ways that a point of service plan encourages you to go to in network providers is by handling the paperwork for you. If you go to a doctor or a medical facility that is in their network, they will handle all of the paperwork for the claim themselves. However, if you go to a doctor or a medical facility that is out of the network, you will have to handle all of the paperwork yourself. This process can be very difficult for some people and it is generally enough to get them to go in network.


With this type of plan, you may need a referral to go to a specialist. Doctors may refer you to someone outside of the network. If this is the case, you need to ask them if they know anyone that they can refer you to inside the network. 

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