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

Methods for payment of the value of a policy. An insurance company can select one of three options in settlement of a loss: make a cash payment; take possession of damaged or destroyed ...

Representative of an insurance company who sells ordinary and industrial life insurance policies. In an effort to move their field forces into the ordinary life business, many industrial ...

Coverage in liability insurance for a ship owner in the event of collision with another ship. A running down clause, when added to basic hull marine insurance, protects against liability ...

Provision in most property insurance policies that permits a policyholder to use the insured premises to store materials and handle them in the manner needed to pursue his or her line of ...

Inland marine policy that protects an insured against loss for property that is shipped. One policy may be written for a single shipment, as for a family moving household goods, or it may ...

Maritime acts resulting in a liability circumstance falling under common law and statutory law. ...

Aggregate of face amount of coverage paid up, or on which premiums are still being paid, as issued by a life insurance company. This is one measure used to rank life insurance companies by ...

Total premiums written by a ceding company minus premiums ceded to its reinsurer. ...

Notice added to the employee retirement income security act (erisa) requiring the employer to disclose the following information concerning the pension plan to the employee: statement ...

Popular Insurance Questions