Definition of "Point-of-service (pos)"

Alixandria Considine real estate agent

Written by

Alixandria Considineelite badge icon

Suncoast Realty Group Llc

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

Section of a policy specifying: parties to the contract (the insurance company and the person or business to be insured); terms of the policy when it goes into force, and when it ends; ...

Dishonest statement to induce an insurance company to write coverage on an applicant. If the company knew the truth, it would not accept the applicant. Fraudulent misrepresentation gives a ...

Insurance policy for which the required premium has been paid. ...

Value or property given by an individual directly to a donee (recipient of the gift), for example, when a father gives a life insurance policy with all ownership rights to his son. ...

Holding company established by a mutual insurance company. The mutual insurance company has 100% ownership of the holding company. ...

Net income expressed as a percentage of average total equity. This percentage measures profitability by expressing how efficiently invested capital or equity is being utilized. ...

1965 federal law that provides for medical assistance to those who cannot afford to pay for it. Four categories of the needy can qualify: aged, blind, disabled, and families with dependent ...

Agreement named after the city of Boston under which insurance companies insure real property in lower socioeconomic neighborhoods if property owners correct any hazards found upon ...

Explicit liability reserve, required by the national association of insurance commissioners (naic), established for all invested asset classes. Specific reserves are established for real ...

Popular Insurance Questions