PSI Ohio Insurance Practice Exam

What is a key characteristic of a point of service plan in health insurance?

1. It offers unlimited specialist visits without referrals.

2. A primary care physician coordinates in-network care.

3. All services are provided without any out-of-pocket costs.

4. Patients can only see doctors within a specific network.

The correct answer is: A primary care physician coordinates in-network care.

A point of service (POS) plan is designed to blend features of both health maintenance organization (HMO) and preferred provider organization (PPO) plans. The primary care physician (PCP) plays a crucial role in a POS plan by coordinating care for patients who choose to seek health services within the network. Patients are generally required to choose a primary care physician, who acts as a gatekeeper to manage their healthcare. This PCP not only provides primary care but also refers patients to specialists when necessary. This model helps to ensure that care is organized and that specialists are utilized efficiently, leading individuals through the healthcare system while managing costs. The other options are characteristic of different types of health insurance plans. For example, unlimited specialist visits without referrals would be more typical of a PPO. The assertion that all services are provided without out-of-pocket costs does not apply to most POS plans, as they usually involve copayments or deductibles. Lastly, the restriction on seeing only doctors within a specific network pertains more to HMOs than to POS plans, which allow for out-of-network options, albeit at a higher cost.