What is generally true about out-of-network services in an HMO plan?

In a Health Maintenance Organization (HMO) plan, out-of-network services are generally not covered unless there is a medical emergency. This means that members are expected to receive care from a network of providers that have established agreements with the HMO to offer services at predetermined rates. If a member chooses to go outside this network for non-emergency services, they will likely have to pay for those services entirely out of pocket.

This approach is designed to manage costs and encourage members to utilize the HMO's network of providers, which typically results in lower overall healthcare costs for both the insurer and the insured. Emergency situations are an exception, as they require immediate attention and often do not have the luxury of considering network affiliations at the moment of crisis. Therefore, coverage for out-of-network services in emergencies is an important safety net for HMO members.

The other options suggest scenarios that are not characteristic of traditional HMO plans. For instance, out-of-network services are not fully covered, nor do they typically involve higher deductibles because HMOs generally operate with little to no deductible cost-sharing within the network. Referrals from any physician are also not a requirement when it comes to out-of-network services; rather, referrals for specialists are typically managed within the HMO