Which plan blends features of HMO and PPO and requires referrals for access to certain providers within primary or secondary networks?

• A. A plan that requires no referrals and provides only a single network.
• B. A plan combining features of an HMO and a PPO, with referrals required within primary or secondary networks.
• C. A plan that covers only dental services.
• D. A plan with unlimited out-of-network costs.

Answer: (B)

This question tests understanding of a health plan that blends features of HMO and PPO while maintaining a referral requirement. A plan like this lets you choose a primary care physician who coordinates most of your care, including referrals to specialists. Referrals are typically needed to access specialists within the network, ensuring coordinated and cost-efficient care like an HMO. At the same time, you may have some flexibility to see providers outside the primary network, similar to a PPO, though usually with higher costs or less favorable coverage. The idea of having a primary network plus secondary network access with referrals describes a Point of Service plan. The other descriptions don’t fit because they either lack the referral structure and mixed-network approach, describe a dental-only plan, or imply unlimited out-of-network costs without the blended structure.