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

Tool of risk management used for risk financing by local governments. The technique is for many local governments to combine resources in order to self insure a particular line of business, ...

Length of employment as measured to determine eligibility, vesting, and benefit levels for employee participants in tax qualified pension plans. There is often a requirement that years of ...

Same as term Captive Agent: representative of a single insurer or fleet of insurers who is obliged to submit business only to that company, or at the very minimum, give that company first ...

Former method of funding a pension plan. When employees retire, the employer sets aside a lump sum that will pay them lifetime monthly benefits. When determining the amount, these factors ...

Total of net investment income plus underwriting income plus other miscellaneous income. This type of income is an indication of how the underwriting function and the investment function of ...

Insurance policy that combines the characteristics of a debit insurance policy with that of an ordinary life insurance policy. These policies were historically sold by the debit agent. ...

Approach used for sole proprietorships, partnerships, and close corporations in which the business interests of a deceased or disabled proprietor, partner, or shareholder are sold according ...

Mortality table used to calculate the legal reserve and life insurance policy cash surrender values. ...

Coverage primarily for the liability of an individual or organization that results from negligent acts and omissions, thereby causing bodily injury and/or property damage to a third party. ...

Popular Insurance Questions