A health plan requires members to select a primary care physician, obtain a referral to see specialists within the network, but also covers out-of-network care at a lower benefit level when the member receives a referral. This combination of features best describes a:

Why A is correct

A Point-of-Service (POS) plan is a managed care hybrid that combines features of an HMO and a PPO. Within the network, the POS plan works like an HMO: members must choose a primary care physician, and referrals are required before seeing a specialist or obtaining other covered care. Outside the network, the POS plan adds limited PPO-style flexibility, covering out-of-network services at a reduced benefit level when the member has obtained the proper referral. That combination of a gatekeeper and partial out-of-network access is the defining characteristic of a POS plan, so A correctly identifies the plan type.

Why the other options are wrong

• B) A pure HMO restricts all covered care to its contracted network and provides no out-of-network benefits in most circumstances, so the out-of-network coverage described in the stem rules out an HMO.
• C) An HSA is a tax-advantaged savings account that is paired with a qualifying high-deductible health plan; it is not a care-delivery plan and has no physicians, networks, or referral rules of its own.
• D) A hospital indemnity policy pays a fixed daily cash benefit for each day of hospitalization regardless of the actual medical bills, and it has no primary care physician, network, or referral structure.

Memory hook

POS = HMO rules inside the network, PPO-style freedom outside — but only with a referral.