Accident & Health FundamentalsQuestion 13 of 716
Which type of managed care plan combines features of an HMO (PCP gatekeeper) with limited out-of-network coverage at a higher cost share?
a.Traditional indemnity plan
b.EPO (Exclusive Provider Organization)
c.Self-funded reinsurance plan
d.POS (Point of Service)
Explanation
A Point of Service (POS) plan blends HMO and PPO features. The member selects a PCP who manages and refers care, but unlike a pure HMO the plan also pays a reduced benefit when the member uses out-of-network providers.
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Related questions on this topic
- 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:
- An Exclusive Provider Organization (EPO) plan is best described as a plan that:
- Which of the following best defines coinsurance?
- The federal Health Insurance Portability and Accountability Act (HIPAA) of 1996 primarily addresses which of the following?
- Covered California is best described as:
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PrepPass team · Verified against California Life & Health Insurance License Exam · How we review
Reviewed by John Zihao Zhang — California-Licensed Life Insurance Agent (CA Dept. of Insurance License #4396095 — verify)