Which plan requires a PCP upon enrollment?

Which plan requires a PCP upon enrollment?

• A. POS
• B. HMO
• C. PPO
• D. Indemnity

Answer: (B)

HMOs coordinate care through a primary care physician who acts as a gatekeeper. When you enroll, you pick a PCP, and most services require referrals from that doctor to see specialists. This gatekeeper model keeps costs down and focuses care within the network, so a PCP designation is a must. That makes this plan the one that requires a PCP upon enrollment. By comparison, a POS can blend gatekeeping with some out-of-network access (often with referrals needed for in-network care), a PPO generally lets you see specialists without a PCP referral (though referrals can help with costs), and indemnity plans typically allow you to see any provider with reimbursement and little to no gatekeeping.

HMOs coordinate care through a primary care physician who acts as a gatekeeper. When you enroll, you pick a PCP, and most services require referrals from that doctor to see specialists. This gatekeeper model keeps costs down and focuses care within the network, so a PCP designation is a must. That makes this plan the one that requires a PCP upon enrollment.

By comparison, a POS can blend gatekeeping with some out-of-network access (often with referrals needed for in-network care), a PPO generally lets you see specialists without a PCP referral (though referrals can help with costs), and indemnity plans typically allow you to see any provider with reimbursement and little to no gatekeeping.