Washington State Insurance Practice Exam

Which of the following best describes the service model of HMOs?

1. Members can choose any provider without restrictions

2. Members must seek care from in-network providers

3. They provide services only in emergencies

4. They focus solely on preventive services

The correct answer is: Members must seek care from in-network providers

The service model of Health Maintenance Organizations (HMOs) is characterized by the requirement that members seek care from in-network providers. This model is designed to provide coordinated care and manage costs effectively. By requiring members to use a network of contracted healthcare providers, HMOs can negotiate lower fees and ensure that care is delivered within a consistent framework. This approach emphasizes the importance of a primary care physician who oversees the patient's healthcare and refers them to specialists within the network as needed. This structure not only helps to control costs but also promotes preventive care and overall wellness among members. In contrast, the other options do not accurately reflect the HMO model. Allowing members to choose any provider without restrictions would describe a fee-for-service model, which is not how HMOs operate. The option stating that services are provided only in emergencies misrepresents the HMO's emphasis on both urgent and routine care. Lastly, while HMOs do prioritize preventive services, stating they focus solely on these services overlooks the comprehensive nature of care they provide, which includes treatment for acute and chronic conditions as well.