A type of health insurance plan that combines features of both Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans, offering flexibility and cost control.

Primary Care Physician (PCP):

A designated healthcare provider within a POS plan who serves as the main point of contact for the insured individual and coordinates referrals to specialists.

In-Network Provider:

Healthcare providers, facilities, or professionals that have contracted with the insurance company to provide services at discounted rates for members of the POS plan.

Out-of-Network Provider:

Healthcare providers or facilities that do not have a contractual agreement with the insurance company, resulting in higher out-of-pocket costs for services received.

Referral:

Authorization from the primary care physician (PCP) for the insured individual to see a specialist or receive certain medical services, ensuring coordinated and cost-effective care.

Co-payment (Co-pay):

A fixed amount that the insured individual pays out of pocket for a covered service, often applicable to visits to healthcare providers or prescription medications.

Deductible:

The amount that the insured individual must pay out of pocket for covered services before the insurance plan begins to cover expenses.

Coinsurance:

The percentage of healthcare costs that the insured individual is responsible for paying after the deductible has been met, with the insurance covering the remaining percentage.

Provider Network:

A list of healthcare providers, hospitals, and facilities that have agreed to provide services to members of the POS plan at negotiated rates.

Gatekeeper:

In a POS plan, the role of the primary care physician (PCP) as the initial point of contact who manages and coordinates the insured individual’s healthcare services.