Question

During a nurses interview for a new job, the health benefits are described as being provided by a health maintenance organization (HMO). What should the nurse expect from this coverage?

1. The nurse will have to choose a provider from within the HMO.
2. The nurse can obtain services from a nonparticipating provider and the HMO will pay for a portion of the charges.
3. For an additional premium, the nurse can choose any provider.
4. By joining this HMO, the nurse is entitled to unlimited treatment and services.

Answer 1

A nurse should expect to choose a provider from within the HMO network and have a primary care physician. Nonparticipating providers are generally not covered. HMO coverage does not guarantee unlimited treatment and services.

Step-by-step explanation:

A Health Maintenance Organization (HMO) is a type of health insurance plan that requires the nurse to choose a provider from within the HMO network. Option 1 is correct. The nurse will have a list of healthcare providers to choose from, and typically needs to select a primary care physician who will coordinate their healthcare.

Option 2 is incorrect. HMOs generally do not cover services obtained from nonparticipating providers, unless it is an emergency situation.

Option 3 is incorrect. HMO coverage usually does not offer the flexibility to choose any provider, regardless of additional premium payments.

Option 4 is incorrect. While HMOs provide coverage for necessary medical treatment and services, it is not unlimited.