HMO PPO: A Hybrid Form of Health Maintenance Organization

D

The correct answer is D. Point-of-service plan.

A point-of-service (POS) plan is a hybrid form of a health maintenance organization (HMO) that provides members with the option to go outside of the HMO network for care. POS plans combine features of both HMO and preferred provider organization (PPO) plans, giving members more flexibility and choice in their healthcare.

Under a POS plan, members typically choose a primary care physician (PCP) from a list of participating providers within the HMO network. The PCP acts as the member's healthcare "gatekeeper," referring them to specialists and other healthcare providers as needed. Members generally pay lower out-of-pocket costs for services provided within the HMO network.

However, if a member needs to see a specialist or receive services outside of the HMO network, they can do so and still receive some reimbursement from the plan. Typically, the reimbursement is at a lower percentage than for services received within the HMO network. The member may also have to pay a higher deductible or coinsurance for out-of-network services.

In summary, a POS plan offers members the option to receive care both within and outside of the HMO network. While members typically pay less for services received within the network, they have the flexibility to seek care outside of the network and still receive some reimbursement from the plan.