California POS Plans

A point-of-service plan (POS) combines elements of both a health maintenance organization (HMO) and a preferred provider organization (PPO). The plan allows you to use a primary care physician to coordinate your care, or you can self-direct your care at the "point of service."

When medical care is needed, you generally have to two or three options, depending on the particular health plan:

1. You can go through a primary care physician, in which case the services will be covered under HMO-like guidelines (i.e., usually just a copayment will be required).
2. You can access care through a PPO provider and the services will be covered under in-network PPO guidelines (i.e., usually a copayment and coinsurance will be required).
3. You can obtain services from a provider outside of the HMO and PPO networks. These services will be reimbursed according to out-of-network rules (i.e., usually a copayment and higher coinsurance charge will be required).