Question

Coverage for care received from a network provider pays more than care received from a non-network provider in what type of health plan?

1) Hospital indemnity
2) Self-insured plan
3) Preferred Provider Organization (PPO)
4) Health Maintenance Organization (HMO)

Answer 1

A network provider offers more coverage than a non-network provider in a Preferred Provider Organization (PPO) health plan, which incentivizes the use of certain providers to manage healthcare costs.

Step-by-step explanation:

Coverage for care received from a network provider pays more than care received from a non-network provider in a Preferred Provider Organization (PPO) health plan. In a PPO, patients have the flexibility to see any medical provider, but they receive greater benefits at a lower cost when using providers within the plan's preferred network. This contrasts with Health Maintenance Organizations (HMOs) where care is typically covered only when received within the HMO's provider network. Both PPOs and HMOs are structured to incentivize patients to use certain providers to manage costs and ensure quality of care. While other insurance models like hospital indemnity or self-insured plans might have different benefits structures, PPOs specifically offer different levels of coverage based on whether a provider is in-network or out-of-network.