South Carolina Life and Health Practice Exam

Which of the following is least likely to provide a form of managed care?

1. Health Maintenance Organization (HMO)

2. Preferred Provider Organization (PPO)

3. Major medical indemnity plan

4. Exclusive Provider Organization (EPO)

The correct answer is: Major medical indemnity plan

A major medical indemnity plan is least likely to provide a form of managed care because it typically operates on a more traditional insurance model. This type of plan focuses on providing coverage for specific medical expenses after the insured has met a deductible, rather than managing care through a network of providers or requiring referrals. Managed care organizations, such as Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Exclusive Provider Organizations (EPOs), utilize specific networks of providers and have established protocols for the delivery of healthcare services. They aim to control costs and improve quality by coordinating care among healthcare providers, managing treatment plans, and often requiring pre-authorization for certain services. In contrast, a major medical indemnity plan generally allows more freedom in choosing healthcare providers but does not implement the same level of care management or cost control features associated with managed care models.