Illinois Health Insurance Practice Exam 2025 – All-in-One Guide to Master Your Health Insurance Certification!

Question: 1 / 400

What requirement is generally associated with HMO plans regarding specialist visits?

No referrals are needed

Members must see a primary care provider first

HMO plans, or Health Maintenance Organization plans, are characterized by a model that emphasizes coordinated care and a primary care provider (PCP)-centered approach. In these plans, members are typically required to select a PCP who is responsible for managing their healthcare. This includes making referrals to specialists when specialized care is necessary. By requiring a visit to a primary care provider before seeing a specialist, HMOs aim to ensure that care is coordinated, costs are controlled, and that members receive appropriate treatments tailored to their health needs. This protocol not only helps streamline healthcare services but also encourages preventive care, as the PCP is in a position to manage the overall health and wellness of the member.

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Specialists are not covered under HMO plans

Members can visit any specialist without restrictions

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