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

Minimum amount of coverage for which a company will write a liability insurance policy. ...

Record a debit (or other) agent makes for premiums collected, time period for which the policy is paid, and the week of collection or date the premium was paid. In essence, the debit agent, ...

In a commercial general liability (comprehensive general liability) policy, exclusion of coverage for sold premises. The objective of this exclusion is to eliminate coverage for property ...

Trust in which assets are controlled through several generations and makes use of generation-skipping tax exemption. ...

Same as term Associate in Research and Planning: professional designation earned after the successful completion of six national examinations given by the insurance institute of America ...

Same as term Cargo Insurance: shipper's policies covering one cargo exposure or all cargo exposures by sea on all risks basis. Exclusions include war, nuclear disaster, wear and tear, ...

Qualified pension or other employee benefit where responsibility rests with an employer rather than an insurer. A trust fund plan, where assets are deposited with and invested by a trustee, ...

Individual who has a contractual agreement with a policyowner. The agent of record has a legal right to commissions from the insurance policy. ...

Net income expressed as a percentage of average total assets. This percentage measures profitability by expressing the efficiency of asset utilization. ...

Popular Insurance Questions