An accident and health plan that covers only services from approved providers is known as which type of plan?

Prepare for the Vermont Life and Health Exam. Use flashcards and multiple-choice questions with detailed explanations to ensure full preparedness. Get confident with your exam!

The correct answer is that an accident and health plan covering only services from approved providers is known as an HMO plan, or Health Maintenance Organization plan.

HMO plans operate by requiring members to use a specific network of healthcare providers and hospitals that have contracts with the HMO. The key characteristic of these plans is that they typically emphasize preventive care and often require members to choose a primary care physician (PCP) who coordinates all of their healthcare needs. If an HMO member seeks care from a provider outside of the approved network, they usually will not receive coverage for those services, which is a defining feature of the HMO structure.

In contrast, PPO (Preferred Provider Organization) plans offer more flexibility, allowing members to see any healthcare provider, but they provide higher benefits for services when using in-network providers. Indemnity plans, also known as fee-for-service plans, allow members to choose any provider without the need for referrals, which is different from the restrictive nature of HMO plans. Exclusive Provider Organization (EPO) plans also limit members to a network of providers but may not require a primary care provider and can provide more flexibility than HMO plans. Nonetheless, they still only cover services from that specific network, similar to an H

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