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What is meant by the term "gatekeeper system"?


A) Members must get authorizations from primary care providers
B) HMO determines the need of care
C) Access to providers is limited
D) Referrals are available only during regular business hours

E) None of the above
F) A) and D)

Correct Answer

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What is a point of service HMO?


A) Member can go outside of HMO providers
B) Members pay for services
C) HMO pays at the time of service
D) HMO only pays for certain services.

E) C) and D)
F) A) and B)

Correct Answer

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What is the purpose of an HMO?


A) Manage health care and costs
B) Manage the providers of health care
C) Increase in health care
D) Decrease costs of health care

E) B) and D)
F) C) and D)

Correct Answer

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Braunvieh HMO limits the numbers of providers available to the subscribers of the plan. This is most likely a


A) Open panel
B) Closed panel
C) Network model
D) Staff model

E) C) and D)
F) A) and B)

Correct Answer

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Which of the following is not a reason for open access HMO?


A) Delays in care
B) Gatekeepers
C) Referral problems
D) Expensive to operate

E) A) and B)
F) B) and C)

Correct Answer

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