Georgia Navigator Practice Exam

What are networks in the context of health insurance?

1. Claims processed by third-party administrators

2. Providers and facilities contracted with an insurer

3. Insurance policies that cover out-of-network services

4. Patients enrolled in a health maintenance organization

The correct answer is: Providers and facilities contracted with an insurer

In the context of health insurance, networks refer to the collection of providers and facilities that have contracted with an insurer to offer services to policyholders. These networks are essential for managing costs and ensuring that patients receive quality care. When a health insurance plan uses a network, it typically means that the insurance company has negotiated rates with these providers, which can lead to lower out-of-pocket expenses for the insured when they seek care from in-network providers. The contractual arrangement helps the insurance company control costs and allows providers within the network to receive a steady flow of patients, benefiting both parties. Understanding this concept is critical for policyholders, as it affects how much they pay for different medical services and their overall experience in accessing care. Therefore, recognizing that networks consist of providers and facilities contracted with an insurer is key to navigating health insurance effectively.