Certified Financial Consultant (CFC) Practice Exam

Can an individual who belongs to a POS plan use an out-of-network physician?

1. No, they can only use network physicians

2. Yes, but at a higher cost

3. Yes, and they must obtain prior approval

4. No, unless they are traveling out of state

The correct answer is: Yes, but at a higher cost

An individual who is part of a Point of Service (POS) plan can indeed utilize the services of an out-of-network physician, but this typically comes with higher out-of-pocket costs compared to using an in-network provider. POS plans combine features of Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs), allowing members some flexibility in choosing healthcare providers. When a member opts for an out-of-network physician, they often face increased co-pays, deductibles, or co-insurance, which varies depending on the plan's specific rules and coverage. Using an out-of-network provider generally requires more careful consideration due to the additional financial implications. While it is possible to receive care from outside the established network, members should be aware that using in-network providers provides the best financial advantage under a POS plan. This aspect of flexibility is a defining characteristic of POS plans, giving members options while also emphasizing the potential added costs of choosing out-of-network care.