Looking at health plan quality, along with choice
of providers, benefits offered, and costs, can help
you decide on a health plan that best meets your needs.
Quality of Care and Service
- Look to see how well the plan performs in each section
of this report.
- Pay special attention to the health issues that
are most important to you and your family.
- Do not focus on small differences in a single measure
that may not be meaningful. When comparing plans,
look at all the factors that contribute to a health
plan's performance and at large differences in the
Choice of Providers
- Make sure that
your preferred doctor, hospital and other providers
participate in the plan by looking in the plan's directory.
You should also call the plan's member services department
or the provider directly.
- Decide whether the plan has enough of the kinds
of doctors you are likely to need and whether they
are located near your home or work.
- Once you have selected a provider, make sure the
doctor has office hours and a location convenient
for you and your family.
- Find out what types of benefits the plan offers
by reviewing the member handbook or calling the member
- Consider your special needs and circumstances such
as chronic health conditions, elder care, frequent
travel, language, retirement and starting a family.
- Decide whether there is a good match between the
benefits offered by the plan and what you think you
- Find out what types of care or benefits the plan
does not offer.
- Try to get an idea of how much you are likely to
pay in premiums, copayments, coinsurance and deductibles
- Find out if the plan covers services by providers
outside the network and how much it will cost you
for these services.
- See if there are any limits on how much you are
responsible for paying in case of major illness (out-of-pocket
- Find out if the plan places limits on the amount
of benefits it will pay (annual or lifetime maximum).
NCQA, also known as the National Committee for Quality
Assurance, is a non-profit organization committed to
assessing, reporting on and improving the quality of
care provided by the nation's health plans. To find
out if your health plan is NCQA accredited, call toll-free
(888) 275-7585 or visit their web site at www.ncqa.org.
URAC, also known as the American Accreditation HealthCare
Commission, is a non-profit organization originally
focused on the accreditation of utilization review programs.
URAC now provides accreditation services for many types
of health care organizations, including HMOs. For information
on URAC's accreditation services, visit the web site:
JCAHO, also known as the Joint Commission on Accreditation
of Healthcare Organizations, is an independent, not-for-profit
organization that evaluates and accredits various types
of health care networks including health plans, hospitals,
home health care organizations and others. For more
information on JCAHO's accreditation services, visit
the web site: www.jcaho.org.