The following statements describe two types, or models, of HMOs:
The Quest HMO has contracted with only one multi-specialty group of physicians. These physicians
are employees of the group practice, have an equity interest in the practice, and provide
______________ HMOs can't medically underwrite any group – incl small groups.
A common physician-only integrated model is a group practice without walls (GPWW). One
characteristic of a typical GPWW is that the
A health plan may use one of several types of community rating methods to set premiums for a
health plan. The following statements are about community rating. Select the answer choice
containing the correct statement.
A health plan's ability to establish an effective provider network depends on the characteristics of the
proposed service area and the needs of proposed plan members. It is generally correct to say that
A health savings account must be coupled with an HDHP that meets federal requirements for
minimum deductible and maximum out-of-pocket expenses. Dollar amounts are indexed annually for
inflation. For 2006, the annual deductible for self-only coverage must
A medical foundation is a not-for-profit entity that purchases and manages physician practices. In
order to retain its not-for-profit status, a medical foundation must
A particular health plan offers a higher level of benefits for services provided in-network than for
out-of-network services. This health plan requires preauthorization for certain medical services.
With regard to the steps that the health plan's claims e
A physician-hospital organization (PHO) may be classified as an open PHO or a closed PHO. With
respect to a closed PHO, it is correct to say that
A public employer, such as a municipality or county government would be considered which of the