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Georgia Individual Health Insurance POS Information Page

 

What is the difference between Georgia indvidual POS health insurance and other types of Georgia individual health insurance plans?

Before we begin to try to understand the different types of Georgia health insurance, there is a bit of information we need to be familiar with. All insurance plans have certain things in common. It would be helpful to understand what they are so you can see how they apply to each type of insurance.

Network - A group of providers, doctors, hospitals, labs, etc. that have a relationship with the insurance company and have established specific pricing for services. This is the way that insurance companies manage their costs.

Out of Network - An out of network provider is any physician, hospital, lab, etc. who does not participate (or "accept") your insurance plan. In the event that you utilize one of these providers, your "out of network" benefit would apply, if your plan includes an out of network benefit.

Deductible-This is the portion of any health charges that you pay before the insurance company pays anything (many plans waive the deductible for physician office visits, instead using an office visit co-pay). ALL plans have a deductible. It may be vary form $0 to $10,000, but it's always included in the plan benefits.

Coinsurance- After the deductible is met, you enter into a period of coinsurance. It's just what the name says. Two entities are paying the health costs during the coinsurance period. When you see the term 80/60 it means that if you stay in network, you pay 20% and the insurance company pays 80% of the charges. Out of network, you pay 40% and the insurance company pays 60%. There is normally a stop loss of $1000 or more that the insured has to pay. In other words, if your plan reads 80/20 through $5000, you would be responsible for 20% of $5000 after the deductible has been met. Then the insured's liability would stop and the insurance company would pay the rest.

Not all plans have coinsurance. Often, you won't find coinsurance in an HMO plan, and often it won't be in an H S A eligible plan.

After the deductible and coinsurance have been met, the insurance company has the liability of any other covered health charges during the plan year.

Now that you have a general definition of insurance terms, let's look at the different types of plans.

The term POS stands for Point of Service (meaning, your amount of benefit depends on the point of service, i.e. in or out of network). Most POS plans operate very similar to an HMO plan with one exception. So, lets start by looking at the HMO and POS "in network" benefits.

HMO and POS health insurance plans offer the broadest type of health coverage available. The deductible can be as low as $0 and many companies offer plans with no coinsurance.

Normally, a POS has a co-pay for most services. The reason we say this is the most comprehensive coverage is that the co-pay covers most of the service that the physician or lab charges. When you go for an office visit, it's all-inclusive in most cases. Sometimes there is even a co-pay for a hospital stay or outpatient surgery. If you encounter coinsurance on a POS plan, it usually will be in conjunction with a deductible for the hospital stay. POS plans usually fully cover the cost of physicals, where the other plans normally have a limit to what they will pay for a physical. A traditional POS plan requires that the insured member get a referral before going to see a specialist with the exception of a Dermatologist, a Psychiatrist, and/or an OB/GYN specialist. There is also an "out of network" benefit in the event that you see a provider who does not accept your insurance plan.

The big difference between an HMO insurance plan and a POS health insurance plan is that the member may utilize providers that are not in the POS network. Like a PPO insurance plan, the member has out of network benefit coverage which is usually a higher deductible and lower coinsurance benefit. These benefits mean that the insured pays more out of their pocket.

Advantages-The POS offers the broader coverage with less out of pocket costs during the plan year. It also has an out of network benefit.
Disadvantages-Primarily less choice in doctors and hospitals to utilize in-network benefits. However, with the increasing popularity of the HMO and POS plans, more physicians, hospitals, labs and other providers are now contracting to accept POS plans which gives much more choice to the insured.

Here are some of the other types of insurance plans that are available in Georgia:
HMO Individual and Group Health Insurance Plans
Open Access HMO Individual and Group Health Insurance Plans
Open Access POS Individual and Group Health Insurance Plans
PPO Individual and Group Health Insurance Plans
H S A Individual and Group Health Insurance Plans
Indemnity Individual and Group Health Insurance Plans

We hope this information is helpful to you. If you would like further information or have questions, please feel free to contact us at Insurance Now and we will spend whatever time is needed to help you make sure that you select the right plan for you.


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Call Holly, Chris or Bob at
(770) 396-9517
Outside of the Atlanta area,
call toll-free: 1-877-711-8376.
fax: 770-396-4318
Email: holly@insurance-now.com