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Question 1

HMO

Answer 1

Health Maintenance Organizations: focuses on preventative care and controlling health costs. PCP is generally the gatekeeper and refers for additional care.

Question 2

PPO

Answer 2

Preferred Provider Organization: use a network of healthcare providers. Out of network providers may be used but insured pays the difference.

Question 3

POS

Answer 3

Point of Service: hybrids of an HMO and PPO. Employee gets to choose which service to use when they see a provider. PCP has to be in network.

Question 4

EPO

Answer 4

Exclusive Provider Network: consists of networking including hospital. Patience’s can only go within network and providers can only see those patients.

Question 5

PHO

Answer 5

Physician Hospital Organization: physician joins a hospital and relays on the PHO structure to develop and market their services.

Question 6

FFS

Answer 6

Fee for Service: most expensive for employees and employers. Everything is paid out of pocket by patients and is reimbursed.