1. An exclusive provider organization (EPO) generally:

Covers care only within its network except for emergencies

An EPO covers services only when received from its network providers, except for emergency care, with little or no out-of-network benefit.

2. In a managed care plan that uses a gatekeeper, the primary care physician:

Coordinates care and provides referrals to specialists

The gatekeeper primary care physician coordinates the member's care and authorizes referrals to specialists.

3. Capitation is a payment method in which a provider is paid:

A fixed amount per member per period regardless of services used

Under capitation, the provider receives a set amount per enrolled member per period, encouraging cost-effective care.

4. Compared with a basic hospital expense plan, a major medical plan typically offers:

Higher overall limits with deductibles and coinsurance for a broad range of expenses

Major medical plans provide broad coverage with higher limits, using deductibles and coinsurance, unlike limited basic expense plans.