MN State Health Insurance|64 Exam Questions And Answers

Information about Health Maintenance Organizations (HMOs) - ️️-Employers with more than 25 employees must offer an HMO as an alternative to their regular health plans. -Reduce cost of healthcare through preventative care -Needs to be approved by MN DHS -Provides services rather than reimbursement -Limited service area and providers -Prepaid basis, physicians paid per head of member (capation) -INPATIENT HOSPITAL CARE IN OR OUT NETWORK Preferred Provider Organization (PPO) - ️️-Physicians paid fees for their services and are not salaried. -Contract with employers, insurers, or third parties to provide medical care at a reduced fee. -In network but members don't have to use the network. -Don't have to select a primary care physician. -Copays and coinsurance will be higher for care out of network. Point of Service (POS) - ️️-A combination of HMOs and PPOs. -Employees not locked into one plan or have to make a choice between two plans. -Choices can be made based on need. -Copays and coinsurance will be higher for care out of network. Cafeteria Plan - ️️type of employee benefit plan that allows insureds to choose between different types of benefits