Other Important Resources
When making health care decisions, consider other sources of information.
Department of Health and Senior Services
The Office of Managed Care in the New Jersey Department of Health and Senior Services monitors the compliance of managed health care plans with New Jersey rules through annual examinations and in-depth reviews of each plan conducted every three years. The office investigates consumer complaints and oversees the Independent Health Care Appeals Program (IHCAP). For information, call the Office of Managed Care toll-free at (888) 393-1062 or visit the Web site, www.state.nj.us/health.
Managed Health Care Consumer Assistance Program
This new program sponsored by the Department gives information and assistance to individuals regarding managed health care and educates health plan members about their rights and responsibilities. It explains the complaints, grievance, and appeal processes that are available to members and helps individuals to determine the process that is most appropriate to their specific situation. The program can also provide help in obtaining and completing the required forms. The toll-free number for the program is (888) 838-3180.
Department of Banking and Insurance
The New Jersey Department of Banking and Insurance (DOBI) publishes Buyers Guides for individual and small employer coverage. You may obtain a copy of the Buyers Guide for individuals at (800) 838-0935 and for small employers at (800) 263-5912. These are also available at DOBIs Web site: www.njdobi.org.
DOBI also publishes a Managed Care Compendium each year. This contains information on enrollment by county, premiums, expenses, hospital utilization, net worth and profitability for all New Jersey HMOs as well as summary information on other managed care companies. Information about this Compendium and related matters are available at the DOBI Managed Care Web site: www.naic.org/nj/managed.htm
For information on managed care options for Medicare in New Jersey, call the New Jersey Department of Health and Senior Services, Division of Senior Affairs, State Health Insurance Assistance Program (SHIP) at (800) 792-8820, or call (800) MEDICARE. You can also visit www.medicare.gov. If you have a complaint about a Medicare managed care plan, refer to your member services handbook for detailed information about where to submit your complaint based on the type of complaint you have.
For information on Medicaid health plan options, quality information and complaints, call the New Jersey Department of Human Services at (800)356-1561 or visit www.state.nj.us/humanservices.