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

Model state law of the NAIC that requires that the insurance policy contain language that meets a readability test (usually, the Flesch readability test that uses a formula approach to ...

Chart showing rate of death at each age in terms of number of deaths per thousand. ...

Expenses added to the beginning of a premium payment period. For example, an annuity with a 10% front load would include $10 of expenses for each $100 premium paid. ...

Type of guaranteed insurance contract in which the term is fixed, the rate is fixed, and the contract owner does not participate in the insurance company's earnings. ...

Historical mortality table that replaced the annuity table, 1949, used for the calculation of annuity rates with more-current mortality experience at that time. This table was subsequently ...

Liability insurance coverage for claims arising from acts that occurred before the beginning of the policy period. Policies written on a claims made basis, such as malpractice liability ...

Division of a sum of money between a deferred annuity and an immediate life annuity certain. ...

Exclusion in property insurance eliminating coverage for damage or destruction of property due to insects. ...

Capacity of parties to an insurance contract to understand the meanings of their action in order for the contract to be valid. ...

Popular Insurance Questions