State RegulationsOH specificDifficulty 2/5
A Dayton member wants to continue seeing her long-time family physician, who does not participate in her HIC's provider network. Under the HIC's limited-choice design, what is the most likely outcome for routine visits to that physician?
Select an option to reveal the answer and the full 3-part explanation — free, no signup.
Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
The HIC model under Ohio Revised Code Chapter 1751 limits members' choice of providers to the HIC's participating network for routine covered services. A physician who does not participate in the network falls outside the delivery system the HIC finances, so routine visits to that physician generally are not covered benefits. The Ohio Department of Insurance supervises this network-based design.
Why the other options are wrong
- A) The HIC controls its own network composition; no obligation exists to add a particular physician at one member's request.
- B) An active Ohio license alone does not make a provider part of the HIC's contracted network.
- C) Equal cost sharing with out-of-network providers would eliminate the limited-choice feature that defines the HIC model.
Memory hook
No network participation, no routine coverage — limited choice cuts both ways.