1. A point-of-service (POS) plan combines features of:

An HMO and a PPO

A POS plan blends HMO and PPO features, using a primary care physician but allowing out-of-network care at higher cost.

2. In a managed care 'gatekeeper' model, the primary care physician:

Coordinates care and authorizes referrals to specialists

The gatekeeper (primary care physician) coordinates the member's care and must authorize referrals to specialists.

3. Under a capitation arrangement, a provider is paid:

A fixed amount per member per month regardless of services used

Capitation pays providers a set amount per enrolled member per month, shifting some utilization risk to the provider.

4. Major medical coverage is characterized by:

High maximum limits with deductibles and coinsurance for a broad range of expenses

Major medical provides broad coverage with high limits, typically subject to a deductible and coinsurance.