Which of the following statements regarding health insurance in an HMO is TRUE?

In a Health Maintenance Organization (HMO), one of the fundamental features is that treatments must be provided within the established network of healthcare providers. This requirement helps manage costs and ensure that members receive coordinated care from a select group of doctors, hospitals, and other healthcare services.

Members are typically required to choose a primary care physician (PCP), who serves as the first point of contact for all health-related issues. If the PCP determines that specialist care or further treatment is needed, they will refer the member to a specialist within the HMO network. This structured approach not only helps maintain cost efficiency but also promotes coordinated care among healthcare providers.

This contrasts with the idea of seeing any doctor without restrictions or choosing specialists without referrals, which are characteristics often found in other types of insurance plans, such as Preferred Provider Organizations (PPOs). Additionally, coverage for out-of-network providers is generally limited or not provided to keep costs manageable for the HMO and its members. Thus, the statement that treatments must be within the established network accurately reflects the operational model of HMOs, making it the true statement regarding health insurance in this context.