During a nurse's interview for a new job, the health benefits are described as being provided by a health maintenance organization (HMO). What should the nurse expect from this coverage?
1. The nurse will have to choose a provider from within the HMO.
2. The nurse can obtain services from a nonparticipating provider and the HMO will pay for a portion of the charges.
3. For an additional premium, the nurse can choose any provider.
4. By joining this HMO, the nurse is entitled to unlimited treatment and services.
1
Rationale 1: An HMO is a geographically organized system that provides an agreed-upon package of health maintenance and treatment services. Providers must be chosen from those in the HMO.
Rationale 2: The HMO system will not pay for services provided "out of network."
Rationale 3: The ability to choose a provider who is "out of network" for an additional premium is a feature of point-of-service plans.
Rationale 4: The HMO provides an agreed-upon package of health maintenance and treatment services. Treatment and services are not unlimited.
Global Rationale:
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