Which term refers to a plan that restricts coverage to in-network providers and often requires a PCP?

• A. Health Maintenance Plan (HMO)
• B. Social determinants of health
• C. Informed consent
• D. Cultural competence

Answer: (A)

A plan that restricts coverage to in-network providers and usually requires a primary care physician to coordinate care is an HMO. In an HMO, you select a PCP who manages your overall care and provides referrals to specialists, which is the gatekeeper role. Because the network is limited and referrals are needed, costs tend to be lower and preventive services are emphasized, but you generally must stay within the network for coverage (except in emergencies). The other terms refer to different ideas: social determinants of health are the nonmedical factors that influence health outcomes; informed consent is about agreeing to treatment after being informed of risks and alternatives; cultural competence is the ability to provide respectful, effective care to people from diverse backgrounds.