Georgia Navigator Practice Exam

Which health plan allows seeking out-of-network treatment with higher deductibles?

1. Exclusive Provider Organization (EPO)

2. Point of Service (POS)

3. Fully-Insured Plan

4. High Deductible Health Plan (HDHP)

The correct answer is: Point of Service (POS)

The option that correctly identifies which health plan allows seeking out-of-network treatment with higher deductibles is the Point of Service (POS) plan. A POS plan combines features of both Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). This means that while a member usually needs a primary care physician's referral to see a specialist, they can also choose to go outside of the network for care. In the case of out-of-network treatment, POS plans typically require higher deductibles and co-payments, reflecting the greater cost associated with receiving services from providers who are not part of the network. This flexibility allows members to access a wider range of healthcare providers while still providing a structured way to manage costs when seeking in-network care. The other options do not offer the same flexibility in terms of out-of-network treatment. Exclusive Provider Organizations generally do not allow members to seek out-of-network care at all. Fully-Insured Plans refer to how the insurance is structured and do not inherently dictate network restrictions; rather, it's the design of the plan itself that would determine the coverage specifics. High Deductible Health Plans primarily focus on lower premiums but higher out-of-pocket costs before the coverage kicks in, and they may or may not allow out