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

Annuity that begins payments after a single premium is paid. For example, the annuitant pays a single premium of $100,000 on June 1 of the current year and begins receiving a monthly income ...

Insurance company's total premium income plus investment income. ...

Allocation of monetary resources to equities. ...

Policy used to provide the funds necessary for buy-and-sell agreements whereby an income payment or a series of income payments are paid to the buyer of the disabled partner's interest ...

Plan to control employer's health care cost through the introduction of practice guidelines or protocols for health care providers, and to improve the methods used by employers and ...

Organization of brokers and securities dealers in the over-the-counter market operating under the auspices of the Securities and Exchange Commission (SEC). Its purpose is to enforce, on a ...

Statement in which a life insurance applicant is charged a higher-than-standard premium to reflect a unique impairment, occupation, or hobby, such as a history of heart disease or a circus ...

Act that prohibits insurance companies, group health plans, and health maintenance organizations from establishing lifetime limits or annual limits on mental health coverage that are lower ...

Coverage underwritten on members of a natural group, such as employees of a particular business, union, association, or employer group. Each employee is entitled to benefits for hospital ...

Popular Insurance Questions