Illinois Health Insurance Practice Exam

The type of health plan that requires members to use a specific network of doctors and services is a Health Maintenance Organization (HMO). In an HMO plan, members are typically required to select a primary care physician (PCP) who coordinates care and provides referrals to specialists within the network. This structure promotes preventive care and helps to manage overall health, but it limits choices because coverage for services rendered by out-of-network providers is usually not available, except in emergencies.

The HMO model emphasizes cost control and efficiency, as it encourages members to seek care from contracted healthcare providers, thus reducing the overall cost of healthcare through negotiated rates and streamlined processes. This contrasts with other types of plans, which may allow for greater flexibility in choosing healthcare providers but often at the expense of higher costs or less coordinated care.