Which plan requires referrals for specialists?

The correct choice is the Health Maintenance Organization (HMO) plan, which is known for requiring referrals for specialist services. In an HMO, members must choose a primary care physician (PCP) who oversees their healthcare. The role of the PCP includes managing the patient's overall care and coordinating referrals to specialists when necessary. This system is designed to ensure that patients receive appropriate care while helping to control costs and maintain a focus on preventive health care.

By requiring referrals, HMOs create a structured framework that encourages members to first consult their PCP before seeing a specialist, ensuring that all medical services are managed in a cohesive manner. This referral process also helps to streamline treatment and maintain continuity of care, which can be beneficial for managing complex health issues.

In contrast, the other plan types do not have this referral requirement. PPOs and EPOs offer more flexibility, allowing members to seek care from specialists without prior authorization or referrals, although PPOs tend to provide a wider network and benefits for using in-network providers. Indemnity plans operate on a fee-for-service basis, where patients can choose their healthcare providers without needing referrals, promoting both freedom of choice and independence in managing healthcare decisions.