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

Actual price paid for property when it was acquired. The original cost might apply to a piece of jewelry, to a piece of equipment, or to a building. For insurance purposes, original cost is ...

Insurance coverage purchased on the same item from two or more insurance companies. ...

Clause in some disability income insurance policies under which there is a maximum an insured can receive from all sources of disability income benefits. For example, the clause may ...

Provision in many property insurance policies that excludes coverage for floods and backup from sewers or drains and underground water. Because floods and hurricanes are generally confined ...

Person who has the responsibility for examining the risk to determine whether or not to insure it. ...

Risk management technique for identifying risks and taking steps to minimize losses. ...

Insurance company that has no outstanding shares of stock, such as a mutual insurance company. ...

Automobile purchased or leased by the insured or the insured's spouse that is in addition to the insured or the insured spouse's present car as covered under the personal automobile policy ...

The term pro rata comes from Latin and translates to in proportion, proportionally, the proportion of, proportionately determined, or according to a specific rate. It is often used in legal ...

Popular Insurance Questions