State RegulationsFL specificDifficulty 2/5
A Florida HMO member needs to see a dermatologist. Under the typical HMO model, the member:
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Under Florida law, HMOs regulated by the Office of Insurance Regulation deliver care through an organized system: members are typically aligned with a primary care provider who coordinates their care and refers them to network specialists when needed. The referral-and-network structure is how the HMO manages both quality and cost, and it is the feature that separates HMO membership from open-access products.
Why the other options are wrong
- A) Full reimbursement for any chosen specialist is the indemnity model, not the HMO's network-and-referral structure.
- C) Specialist care obtained through the plan's delivery system is a covered service; members do not simply pay alone.
- D) Members are not shuffled to a second HMO; the same organization's delivery system handles specialist referrals.
Memory hook
In an HMO, the primary care provider is the gatekeeper.