意外与健康保险基础第 341 / 716 题
A key difference between a Health Maintenance Organization (HMO) and a Preferred Provider Organization (PPO) is that an HMO typically:
a.Lets members see any out-of-network provider at the same cost sharing as in-network care
b.Reimburses members on a pure fee-for-service basis with no provider network and no negotiated discounts
c.Provides no coverage for routine preventive care such as annual physicals and screenings
d.Requires members to use network providers and often a primary care physician who coordinates referrals
解析
HMOs emphasize managed care: members generally must use in-network providers and often select a primary care physician (a gatekeeper) who coordinates care and referrals to specialists, in exchange for lower costs. A PPO offers more flexibility, allowing out-of-network care at a higher cost, so identical cost sharing in and out of network is not accurate for either an HMO or a PPO. Pure fee-for-service reimbursement with no network describes a traditional indemnity plan. HMOs actually stress preventive care, so saying they cover no routine physicals or screenings is wrong.
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审核人 John Zihao Zhang — California-Licensed Life Insurance Agent (CA Dept. of Insurance License #4396095 — 核实)