Arkansas Life and Health Insurance Practice Exam

Which type of health plan restricts members to using the healthcare providers who are part of the plan’s network?

1. EPO

2. HMO

3. PPO

4. POS

The correct answer is: EPO

An Exclusive Provider Organization (EPO) health plan restricts its members to using healthcare providers who are part of the plan's network. EPO plans typically do not provide coverage for any services received outside of the network, except in cases of emergency care. This restriction helps control costs for both the insurance company and the insured individual by encouraging the use of in-network providers who have negotiated discounted rates. HMO (Health Maintenance Organization) plans also have a network of healthcare providers but require members to select a primary care physician (PCP) and obtain referrals from the PCP to see specialists. PPO (Preferred Provider Organization) plans offer more flexibility in choosing healthcare providers, with the option to see both in-network and out-of-network providers. However, using in-network providers usually results in lower out-of-pocket costs. POS (Point of Service) plans combine elements of HMO and PPO plans, allowing members to choose whether to use in-network or out-of-network providers at the time of service. However, using out-of-network providers typically results in higher costs for the insured individual.