Kentucky Health Insurance Practice Exam

Which of the following is NOT considered a basic benefit of an HMO plan?

1. Preventive services

2. Out of area service

3. Diagnostic laboratory services

4. Prescription drugs

The correct answer is: Prescription drugs

In the context of Health Maintenance Organizations (HMOs), the focus is typically on providing a range of health services aimed at prevention and wellness, including preventive care, diagnostic services, and often managing chronic conditions. Preventive services, diagnostic laboratory services, and in many cases certain prescription drugs can fall within the basic benefits provided by HMOs. The specific characteristic of HMOs is that they usually require members to choose a primary care physician and obtain referrals for specialist services. Out of area services are generally not covered unless there is an emergency, making this an atypical benefit for an HMO. Prescription drugs can vary; while many HMO plans do include them, they are often not considered a core benefit in the same way as preventive services and routine care, which are central to the organization's structure. Therefore, the inclusion of prescription drugs as a "basic benefit" can be inconsistent among various HMO plans, which is why it is considered more of a supplementary benefit rather than a fundamental one. This distinction highlights the general structure and intent of HMO plans to prioritize comprehensive primary care and preventive measures, as well as cost-containment strategies, which often leave out extensive drug coverage as part of the essential offerings.