Final answer:
In a POS health plan, members usually need a referral from their PCP to see a specialist, emphasizing the plan's focus on coordinated and efficient healthcare.
Step-by-step explanation:
In a Point of Service (POS) health plan, a member generally needs a referral from their Primary Care Physician (PCP) to see a specialist.
A POS (Point of Service) plan is a type of managed-care health insurance plan that combines features of Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans. Similar to HMO plans, POS plans require plan members to select a Primary Care Physician (PCP) who coordinates their care. When a member requires the services of a specialist, they typically need to obtain a referral from their PCP. Failing to get a referral may lead to higher out-of-pocket costs or the plan might not cover the visit at all.
However, emergency services are usually an exception where a referral is not necessary. The referral requirement encourages the use of a coordinated approach to healthcare, aiming to improve the quality and efficiency of care by establishing a central point of care management.