Practice Quiz

PHR Human Resources

Category - PHR

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Under Pie in the Sky`s health plan, employees are not required to submit insurance claims if they go to a group of participating doctors and hospitals, since these providers are direct employees of the health care provider. Most likely, what type of health care plan is Pie in the Sky using?
  1. PPO
  2. POS
  3. Staff model HMO
  4. IPA model HMO
Explanation
Answer: C - Most likely, Pie in the Sky is using the staff model HMO plan.

Key Takeaway: Group Model Health Maintenance Organizations (usually shortened to HMOs) create contracts with individual groups of practitioners who provide services to employees. Staff model HMOs directly employ health care professionals and physicians on staff.
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