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

Same as term Annual Statement: report that an insurance company must file annually with the State Insurance Commissioner in each state in which it does business. The statement shows the ...

Expense of defending a lawsuit. To mount a legal defense against civil or criminal liability, a defendant faces expenses for lawyers, investigation, fact gathering, bonds, and court costs. ...

Clause in an insurance policy that describes the administration and submission of claims procedure. ...

Time frame during which an annuitant makes premium payments to an insurance company. The obligations of the company to the annuitant during this period depend on whether a pure annuity or ...

Vehicle for the deferring of unneeded current income for a later date, such as retirement, providing the following benefits: There is no tax on earnings of the plan until distributed; ...

Period, set by law, after which a damage claim cannot be made. Limits are set by individual states and usually range from one to seven years. ...

Individual receiving medical treatment who is not required to be hospitalized overnight. ...

Provision found in juvenile insurance that waives the premiums due on the insured child's policy provided that the payor of the premiums becomes totally disabled or dies before the child ...

Long-term investment plan strategy under which all of the investor's investable assets are divided into predetermined proportions among several different types of securities. In theory, ...

Popular Insurance Questions