Definition of "Point-of-service (pos)"

Device that enables the health maintenance organization (HMO) to present a premium quotation to the employer that would encourage the employer to replace the current health carrier. The POS offers three options for the delivery of health care:

  1. traditional gatekeeper (GK) option HMO network provides the care and there is a gatekeeper director.
  2. open access (OA) option HMO network provides the care but there is no gatekeeper director. At the time care is required, the member selects the provider.
  3. out-of-network option (OON) care is permitted outside the HMO network and there is no gatekeeper director. At the time care is required, the member selects the provider.
The member has increasing payments under the OA and OON options as compared with the GK option. For example, the GK option may have a $15 physician CO PAYMENT and provide total hospital benefits. The OA option may have a $30 physician co payment with a 10% COINSURANCE requirement. The OON option may provide for a $500 DEDUCTIBLE, an 80/20 coinsurance requirement until the employee's out-of-pocket medical expenses reach $5000, and then the plan would pay all expenses up to a $750,000 lifetime maximum.

image of a real estate dictionary page

Have a question or comment?

We're here to help.

*** Your email address will remain confidential.
 

 

Popular Insurance Terms

Addition to reflect exposures with a greater probability of loss than standard exposures. For example, insuring a munitions factory obviously requires a premium greater than that required ...

Acknowledgment by the policyowner that he or she has received the policy loan requested. ...

Determination that group plans offering legal services are limited to an annual tax-free benefit of $70 per employee; group plans may offer employer-provided educational assistance plans on ...

Group of women life insurance agents who sell sufficient insurance to qualify for membership. The round table is sponsored by the NATIONAL ASSOCIATION OF LIFE UNDERWRITERS (NALU). ...

Acceptance by a reinsurer of part or all of a risk that has been transferred to it by a primary insurer or another reinsurer. ...

Right of an insured to make additional purchases of life insurance without having to take a physical examination or show other evidence of insurability. Additions can be bought at stated ...

Amount borrowed against the cash value of a life insurance policy to pay the premium due. ...

Same as term Extended Coverage Endorsement: added to an insurance policy or a clause found in an insurance policy that will provide additional coverage for risks to be insured other than ...

Assumption of total disability when an insured loses sight, hearing, speech, or a limb. When such a loss occurs to an insured with disability income insurance, the insurer often assumes ...

Popular Insurance Questions