What Is an HMO Point of Service (POS) Plan?

An HMO POS plan is a Health Maintenance Organization (HMO) plan with added Point of Service (POS) benefits. These added benefits give you more flexibility when you need care.

Under the HMO benefits of the plan, you have access to certain doctors and hospitals, called your HMO provider network. You choose a primary care physician (PCP) from the HMO network who will manage your care. You’ll need a referral to see a specialist to receive the HMO benefits.

With a Blue Cross and Blue Shield of Texas HMO POS plan, you also have the choice to go outside the network or see a specialist without a PCP referral. When you do this, the cost of the care will be covered at the POS benefit level, which is lower than in-network coverage. This means you’ll pay more out-of-pocket, but will have some benefits you wouldn’t have with an HMO.

When using your POS plan benefits:

  • You’ll pay more of the bill when you see an out-of-network provider, or see a network provider without a referral from your PCP.
  • You’ll have a higher deductible and coinsurance costs.
  • Your benefits may cover only part of the costs.

Is an HMO POS Right For You?

Before you choose an HMO POS plan, consider the pros and cons. You should decide if the added benefit of being able to go out of network or be seen without a PCP referral is worth the added premium and out-of-pocket costs. Be sure to look at the plan details, fees, out-of-pocket costs, deductibles and copays. If you think you can get the care you need from the health care providers in the HMO network, an HMO may be all you need.

Pros of an HMO

  • Premiums are often lower than a PPO health plan.
  • You can get care outside of the HMO network or without a referral and still have some of your health care costs covered.
  • POS coverage allows you to mix the types of care you receive. For example, your child could continue to see his in-network pediatrician, while seeing an out-of-network specialist.

Cons of an HMO POS

  • Premiums and copays are often higher than an HMO health plan.
  • If you go out of network or receive services without PCP referral, providers may ask that you pay the entire bill when they see you.
  • There is no out-of-pocket maximum, which means you’ll always pay your portion of the costs.
  • Expect more paperwork. When you go out of network, you’ll have to file your own claims to get reimbursed. This means you’ll need to keep track of your receipts.

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Last Updated: April 18, 2023