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

Government group that provides reinsurance for private insurers that write riot and civil commotion insurance. Riot losses in major cities in the 1960s caused insurers to stop writing this ...

Legislation that provided temporary rules for implementing the employee retirement income security act of 1974 (erisa). ...

A newer generation of life insurance policies that are credited with interest currently being earned by insurance companies on these policies. ...

That which adjoins. Most property insurance policies such as the homeowners insurance policy provide structural coverage on an adjacent building on the same basis as the primary building. ...

Financial instrument traded on the Chicago Board of Trade (CBOT). By purchasing this future, the insurance company can hedge its risk exposure against possible future catastrophic losses. ...

Trust established under the auspices of the Internal Revenue Code that permits the maintenance of a separate account within the employer's defined benefit pension plan from which to pay the ...

An exception to section 101 (a) (1) OF THE INTERNAL REVENUE CODE tax-exempt Status Of the DEATH BENEFIT in a life insurance policy where the transfer of the interest in the policy by the ...

Time interval during which policy is in force. ...

Option clause in a disability income policy that the insured can exercise that would permit the insured the right to purchase additional limits of coverage regardless of the insured's ...

Popular Insurance Questions