Question

An insured's medical expense plan pays a higher benefit when health care services are rendered by a physician within the plan's network. This indicates that the plan is NOT a(n):

A. HMO
B. traditional medical expense plan
C. PPO
D. managed care plan

Answer 1

An insured's medical expense plan paying a higher benefit when health care services are rendered by a physician within the plan's network indicates that the plan is not a traditional medical expense plan, but rather a Preferred Provider Organization (PPO).

Step-by-step explanation:

An insured's medical expense plan paying a higher benefit when health care services are rendered by a physician within the plan's network indicates that the plan is not a traditional medical expense plan. A traditional medical expense plan typically reimburses medical costs regardless of the provider's network affiliation.

In this case, it is likely that the plan is a Preferred Provider Organization (PPO). In a PPO, insured individuals have the flexibility to choose healthcare providers both within and outside the plan's network, but the plan provides higher benefits if services are obtained from network physicians.