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

Specific values of securities computed annually by the national association of insurance commissioners (NAIC) as guidelines and procedures for insurance companies in listing of their ...

Coverage that guarantees that the insurance company will pay the insured business or individual for money or other property lost because of dishonest acts of its bonded employees, either ...

Frequency and severity of accidents resulting from conditions and environment surrounding one's workplace. Occupation is an important underwriting factor when considering an applicant for ...

difference between the face value of a permanent life insurance policy and its accrued cash value. The pure cost of protection is based on this difference. For example, if the face value ...

Legislation passed in 1988 by the U.S. Congress to facilitate movement of checks through the collection system. As the result of this Act, the Federal Reserve has established rules for the ...

Sum total of the annual effective rate of return earned by an owner of a bond if that bond is held until its maturity date. This effective return includes the current income generated by ...

Same as term Deposit Term Life Insurance: policy in which a premium (the deposit) is paid in the first policy year, in addition to the regular term insurance premiums required. The deposit ...

Subtraction of a number of years from a standard table of life insurance rates under the assumption that a particular group-women-outlive men and presumably will be paying premiums for a ...

Physician who conducts physicals of applicants for life and/or health insurance. This physician is selected by the insurance company at its expense. ...

Popular Insurance Questions