Washington State Insurance Practice Exam

What is a characteristic of a health maintenance organization (HMO)?

1. It allows members to seek any provider

2. It operates without networks

3. It requires members to use healthcare services from a network of providers

4. It provides only emergency medical services

The correct answer is: It requires members to use healthcare services from a network of providers

A health maintenance organization (HMO) is characterized by its requirement for members to utilize a specific network of healthcare providers. This model emphasizes coordinated care and emphasizes preventive services, which are key components in managing overall health and controlling costs. By requiring members to choose from a network of doctors and facilities, HMOs aim to streamline healthcare delivery and reduce unnecessary treatments or services. Members typically need to select a primary care physician (PCP) who acts as a gatekeeper for accessing specialty care, which further ensures that the care they receive is aligned with the organization's guidelines and strategic objectives focused on maintaining members' health rather than just treating illness. This structure not only promotes accountability among providers but also fosters a holistic approach to patient care. The other options do not align with the fundamental workings of an HMO. Seeking any provider or operating without networks describes features more aligned with traditional fee-for-service insurance models, while providing only emergency services is too restrictive and does not encompass the preventive and comprehensive services typically offered by HMOs.