Accident & Health FundamentalsQuestion 12 of 315
An Exclusive Provider Organization (EPO) plan is best described as a plan that:
a.Pays for any provider nationwide with no network restriction
b.Limits non-emergency coverage to in-network providers but typically does not require a PCP referral
c.Combines Medicare and Medicaid benefits
d.Requires a PCP gatekeeper and pays partial benefits out-of-network
Explanation
An EPO restricts non-emergency benefits to the in-network panel of providers, much like an HMO, but unlike a traditional HMO it generally does not require a PCP referral to see specialists. Out-of-network non-emergency care is usually not covered.
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Related questions on this topic
- Which of the following is NOT one of the ten Essential Health Benefits categories that an ACA-compliant individual or small group plan must cover?
- A health plan has a $2,000 deductible, 20% coinsurance, and a $7,500 out-of-pocket maximum. Once the insured reaches the out-of-pocket maximum, in-network covered services for the rest of the plan year are paid at:
- A key structural difference between a traditional HMO and a Preferred Provider Organization (PPO) is that the HMO:
- Which type of managed care plan combines features of an HMO (PCP gatekeeper) with limited out-of-network coverage at a higher cost share?
- Which of the following best defines coinsurance?
- The federal Health Insurance Portability and Accountability Act (HIPAA) of 1996 primarily addresses which of the following?
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