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.Requires a PCP gatekeeper and pays partial benefits out-of-network
c.Combines Medicare and Medicaid benefits
d.Limits non-emergency coverage to in-network providers but typically does not require a PCP referral
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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- Which type of managed care plan combines features of an HMO (PCP gatekeeper) with limited out-of-network coverage at a higher cost share?
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