Managed care plan in which members are given a choice as to how to receive services, whether through an HMO, PPO, or fee-for-service plan. They may choose a nonparticipating provider (higher cost) or participating provider, with different levels associated with the use of participating providers, and with or without a referral. The decision is made at the time the service is necessary (i.e., “at the point of service”); sometimes referred to as open-ended HMOs, point-of-service (POS) program, swing-out HMOs, self-referral options , or multiple option plans.