Under a typical HMO plan, a member who is traveling out of state and suffers a medical emergency should expect that:

Why A is correct

Although an HMO generally limits benefits to its contracted network, emergency services are the recognized exception: a member who experiences a medical emergency — judged by the prudent layperson standard — is covered even when treated at an out-of-network hospital. The exception extends to the emergency screening and treatment, but once the member is stabilized, follow-up and non-emergency care must be obtained from in-network providers. This emergency exception is tested as a boundary to the HMO's network-only rule. This boundary is a common exam scenario.

Why the other options are wrong

• B) HMOs must cover emergency care received out of network; a blanket 'never covered' statement ignores the emergency exception. The prudent layperson standard requires coverage of true emergencies regardless of location.
• C) The emergency room treatment itself is the covered service; transportation is only incidental and not the point of the exception. The emergency room visit itself is the covered service under the exception.
• D) Emergency care carries its own cost-sharing (typically an emergency room copay or coinsurance), which is not the same as an office visit copay. Emergency room copays differ from office visit copays by design.

Memory hook

HMO walls have one emergency exit: true emergencies get covered out of network; follow-up care comes home to the network.