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

High severity loss that does not lend itself to accurate prediction and thus should be transferred by the individual or business to an insurance company. ...

Service under the auspices of the medical information bureau (MIB) that provides the insurance company with nonmedical information concerning the APPLICANT for DISABILITY INCOME INSURANCE. ...

Elements within a group under study that have the same characteristic (s), have the same expectation of loss, are very much alike with respect to the variable under consideration, and do ...

Same as term Accidental Death and Dismemberment Insurance: form of accident insurance that indemnifies or pays a stated benefit to insured or his/her beneficiary in the event of bodily ...

Frequency of death. ...

Individuals who inherit assets as the result of being named in a will. ...

Statistical procedure used to calculate a premium rate based on the loss experience of an insured group. Applied in group insurance, it is the opposite of manual rates. Here the premiums ...

Provision of federal legislation that prohibits an employer from making contributions (premium payments) directly to a union for the purchase of employee benefits; instead the contributions ...

Hazard covered under catastrophe reinsurance. This form of excess of loss reinsurance protects the ceding company for loss above the retention limit caused by multiple catastrophic events. ...

Popular Insurance Questions