Which term describes a plan that blends PPO flexibility with HMO gatekeeper?

Which term describes a plan that blends PPO flexibility with HMO gatekeeper?

• A. Indemnity Plan (Fee-for-Service)
• B. Point of Service (POS) Plan
• C. PPO
• D. Primary Care Gatekeeper

Answer: (B)

POS plans combine the flexibility of choosing providers with a primary care physician who coordinates care and acts as a gatekeeper. You usually get the lowest costs by staying in-network and obtaining referrals for specialist services, but you also have the option to see out-of-network providers if you want more choice, albeit with higher costs. This blend of in-network gatekeeping and outside-network freedom is what makes a POS plan fit the description. Indemnity plans are typical fee-for-service arrangements with little to no gatekeeping or required referrals, focusing on reimbursing whatever provider you choose. PPO plans emphasize broad provider choice and out-of-network coverage without requiring referrals, so they generally don’t include a gatekeeper. The term Primary Care Gatekeeper refers to the role of a PCP, not a plan type that itself blends features.

POS plans combine the flexibility of choosing providers with a primary care physician who coordinates care and acts as a gatekeeper. You usually get the lowest costs by staying in-network and obtaining referrals for specialist services, but you also have the option to see out-of-network providers if you want more choice, albeit with higher costs. This blend of in-network gatekeeping and outside-network freedom is what makes a POS plan fit the description.

Indemnity plans are typical fee-for-service arrangements with little to no gatekeeping or required referrals, focusing on reimbursing whatever provider you choose. PPO plans emphasize broad provider choice and out-of-network coverage without requiring referrals, so they generally don’t include a gatekeeper. The term Primary Care Gatekeeper refers to the role of a PCP, not a plan type that itself blends features.