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

Property and/or liability coverage for a municipality. Municipalities are responsible for maintenance of through ways as well as a myriad of public services. Liability insurance for ...

Method of rating that compares property to be insured to a standard and adjusts the rate for deviations from the standard. A standard building is situated in a standard city of specific ...

Historical record of dividends paid. ...

One of four SEC divisions that administers the procedure through which public companies must disclose all relevant material in order that a potential investor might make an informed ...

Written contract between an insured and an insurance company stating the obligations and responsibilities of each party. ...

Circumstance that increases the probability of loss because of the insured's indifferent attitude. For example, if an insured leaves the doors unlocked and the windows open when leaving ...

Provision under the Internal Revenue Code, Chapter 13, that specifies a transfer tax of 55% of the gift to a person at least two generations younger than the transferor (person who gives ...

Right that has a limited time in duration for an individual to receive the income generated by assets owned by another individual. ...

Measurement of the response of the cash flow of an insurance company to various interest rate scenarios; for example, how rising interest rates will affect the number of life insurance ...

Popular Insurance Questions