A Point-of-Service (POS) plan is BEST distinguished from a pure HMO by which of the following features?
Explanation
A Point-of-Service (POS) plan is a managed-care hybrid that gives the member a choice 'at the point of service.' In-network with a primary-care-physician referral, the member receives HMO-level benefits with low cost-sharing. Out-of-network or without a referral, the member can still get covered care, but at PPO-like cost levels (a higher deductible, higher coinsurance, and balance-billing risk). POS plans are regulated under Knox-Keene when the HMO core is a health care service plan. Option A is wrong; POS plans have networks. Option B is wrong; the very point of the structure is to make out-of-network MORE expensive, not free. Option C is fabricated. The defining feature is the two-tier benefit structure tied to whether the member uses the HMO core or steps outside it.
Law Reference: California Health & Safety Code §1374.16 et seq. (POS / referrals); Knox-KeenePractice all 315 questions free — no signup required.
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