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

Coverage available under two forms for actual or attempted robbery of money, securities or other property. Under the First Form the policy covers if the robbery is committed on the premises ...

Frequency of death. ...

Written form which has precisely the same terms as the other property insurance policies covering a particular property. ...

Mutual insurance association that issues insurance to its members on a nonprofit basis. Examples of such associations include fraternal societies, unions, and employee membership groups. ...

Statement showing assets and liabilities of an individual. ...

Act that prohibits employers from discriminating against employees in employee benefit plans, regarding contributions or benefits based on race or gender. ...

Party that shares in the loss under an insurance policy or policies. ...

Detailed descriptive list made available to the survivor (s) of the insured showing: attorney, accountant, insurance agent, and location of important documents such as wills, power of ...

Marine cargo coverage for a single shipment of goods. Also known as special risk insurance and trip cargo insurance. Contrasts with open policy cargo insurance that covers all of a ...

Popular Insurance Questions