State RegulationsFL specificDifficulty 3/5
Which statement correctly distinguishes a Florida PPO from an HMO?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Under Florida law, both plan types are overseen by the Office of Insurance Regulation, but they differ in access structure: a PPO combines a discounted provider network with the member's freedom to self-refer, even outside the network at reduced benefits, whereas the HMO is a prepaid plan whose benefits revolve around its contracted network and primary-care referral system. Recognizing who controls the gate to care is the fastest way to tell the products apart on the exam.
Why the other options are wrong
- A) The positions are reversed: PPOs permit out-of-network use, while HMO benefits are built around the contracted network.
- B) The prepaid, organized delivery model is the HMO's, not the PPO's; PPOs are network discount arrangements.
- D) The PPO's whole design rests on its contracted network; it is the HMO comparison, not the PPO, that has no network.
Memory hook
PPO = freedom with a price tag; HMO = network and referrals.