State RegulationsVA specificDifficulty 1/5
Which description best fits a health maintenance organization (HMO) as regulated in Virginia?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Virginia's HMO statutes, beginning at Va. Code § 38.2-4300 and detailed further by the administrative rules at 14 VAC 5-211-10-280, regulate HMOs as organized systems of health care delivery: an HMO provides or arranges comprehensive health services for voluntarily enrolled members in exchange for a fixed, prepaid amount rather than reimbursing bills after they arrive. The prepaid, organized-delivery model is what separates an HMO from traditional indemnity reimbursement, and the Commission supervises it through the Virginia Bureau of Insurance under Virginia law.
Why the other options are wrong
- A) Pure after-the-fact bill reimbursement with no delivery system describes indemnity coverage, not the prepaid organized model Virginia defines at Va. Code § 38.2-4300.
- C) A Medicare contractor participates in a federal program; the HMO is a state-regulated entity under the Virginia Insurance Code and the administrative rules.
- D) A discount card assumes no responsibility for care; an HMO is responsible for providing or arranging comprehensive services for its members.
Memory hook
HMO = prepaid care through an organized system, not bills reimbursed later.