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

Insurance policy that combines the elements of a deferred annuity with the elements of DECREASING TERM LIFE INSURANCE. This policy was originally designed to act as a funding instrument for ...

Portion of reinsurance premium received by the reinsurer that relates to the unexpired part of the reinsured policy. ...

Coverage for bodily injury and property damage liability resulting from the ownership, use, and/or maintenance of an insured business's premises as well as operations by the business ...

Worst case scenario under which an estimate is made of the maximum dollar amount that can be lost if a catastrophe occurs such as a hurricane or firestorm. ...

Money set aside to pay for losses. Rather than buy insurance coverage for all potential losses, some businesses and individuals choose this form of self insurance to cover all or a portion ...

actual fire losses divided by the total value of the property exposed to the peril of fire; actual losses resulting from fire divided by the total fire amount of in-force business. ...

Deductible eliminated through the payment of an additional premium, resulting in first-dollar coverage under the policy. ...

Provision of a property insurance policy which covers conditions usually present in a particular location. For example, there is an inherent risk of explosion in a flour mill. ...

Arrangement, often funded by life insurance, to continue an employee's salary in the form of payments to a beneficiary for a certain period after the employee's death. The employer itself ...

Popular Insurance Questions