1. A point-of-service plan combines features of which two arrangements?

An HMO and a PPO

A point-of-service plan blends HMO and PPO features, letting members choose in- or out-of-network care at the time of service.

2. Capitation refers to paying a provider:

A fixed amount per member regardless of services used

Capitation pays providers a set amount per enrolled member per period, regardless of the volume of services.

3. Utilization review in managed care is used to:

Evaluate the necessity and efficiency of care

Utilization review assesses whether care is medically necessary and delivered efficiently.

4. A usual, customary, and reasonable charge is used to:

Determine the amount a plan will pay for a service

UCR charges help establish the amount a plan considers reasonable to pay for a given service in an area.