Which plan blends features of an HMO and a PPO, allowing selection from a primary or secondary network with referrals required?

• A. A plan that is identical to a traditional HMO with no out-of-network options.
• B. A plan combining features of an HMO and a PPO, allowing selection from a primary or secondary network with referrals required.
• C. A plan that only covers catastrophic events.
• D. A plan that permits exclusive out-of-network provider use with no referrals.

Answer: (B)

A plan that blends features of an HMO and a PPO is a Point-of-Service (POS) plan. It combines gatekeeping with a referral requirement (like an HMO) with the option to receive care outside the primary network (like a PPO), though typically at higher costs or with limited coverage. This arrangement lets you choose a primary network and use a primary care physician to coordinate care and referrals, while also allowing you to go to a secondary, out-of-network option if needed, accepting the trade-offs in coverage and cost.

The other descriptions describe plans that don’t mix these elements: one is strictly in-network with no out-of-network options, another covers only catastrophic events, and another allows exclusive out-of-network use with no referrals. None of those capture the combination of referral-based gatekeeping and network flexibility that defines a POS plan.