意外与健康保险基础第 482 / 716 题
In an HMO, the primary care physician often serves as a 'gatekeeper,' which means the physician:
a.Sets the plan's annual deductible amount and the coinsurance percentage members owe
b.Coordinates the member's overall care and provides referrals to specialists
c.Owns and operates the HMO
d.Collects the plan's monthly premiums
解析
As a gatekeeper, the primary care physician manages the member's overall care and must generally provide a referral before the member sees a specialist, which helps the HMO control costs and avoid unnecessary services. The gatekeeper does not collect premiums, own the HMO, or set the deductible. The gatekeeper model is a defining feature of traditional HMOs and a key difference from PPOs, which usually let members self-refer to specialists.
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同考点相关题目
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审核人 John Zihao Zhang — California-Licensed Life Insurance Agent (CA Dept. of Insurance License #4396095 — 核实)