Practice Quiz

Health and Life Insurance

Category - HMOs

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Serendipity HMO contracts with an independent medical group that specializes in a variety of medical services to provide the HMO subscribers comprehensive coverage. Under this arrangement, Serendipity HMO pays the medical group entity not the individual service providers. Serendipity HMO most likely operates as:
  1. Group model
  2. Staff model
  3. Network model
  4. Closed panel
Explanation
Answer: A - Serendipity HMO most likely operates as a group model HMO. Under the group model, the HMO pays the medical group who in turn pays the medical providers. It is up to the medical group to determine how to pay the providers who remain independent of the HMO instead of becoming a salaried employee. The group model has contracts with the HMO and the medical group and not independent providers.
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