Which statement accurately describes POS plans?

Which statement accurately describes POS plans?

• A. They require referrals for all specialists and never cover out-of-network care
• B. They do not allow out-of-network dentist visits
• C. PCP must be in-network; may use out-of-network with higher costs
• D. They are the same as HMO with no out-of-network coverage

Answer: (C)

POS plans blend features of HMOs and PPOs. The defining idea is you must choose an in-network primary care physician who coordinates your care, but you can go out-of-network if you’re willing to pay higher costs. This combination means you get the cost control and referral-style coordination when you stay in-network, while still having the option to seek care outside the network at increased expense. The other statements describe plan features that don’t match this hybrid structure—situations like no out-of-network coverage (as in some HMOs) or restricting care to in-network providers without the flexibility POS offers.

POS plans blend features of HMOs and PPOs. The defining idea is you must choose an in-network primary care physician who coordinates your care, but you can go out-of-network if you’re willing to pay higher costs. This combination means you get the cost control and referral-style coordination when you stay in-network, while still having the option to seek care outside the network at increased expense. The other statements describe plan features that don’t match this hybrid structure—situations like no out-of-network coverage (as in some HMOs) or restricting care to in-network providers without the flexibility POS offers.