2016 HMO and PPO Performance Report
The State of New Jersey
NJ Department of Banking and Insurance

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2016 New Jersey HMO and PPO Performance Report

This report was developed by the New Jersey Department of Health. It issued the first HMO performance report in 1997 with the cooperation of an advisory group representing HMOs, health care purchasers, providers and consumers. The New Jersey Department of Banking and Insurance (DOBI) assumed responsibility for providing the HMO Performance Report from the New Jersey Department of Health in August 2005. Regulatory matters concerning managed health care in the state are now at DOBI.

In 2014, DOBI expanded this report on health plan performance by including data for PPOs. DOBI has compiled a single performance report to show side-by-side results of HMOs and PPOs, making the publication more meaningful to employers, employees, and individual purchasers of health insurance. 

This report includes information on all commercial managed care products currently marketed in New Jersey by HMOs or PPOs that had at least 2,000 members enrolled in these products in both 2014 and 2015. For HMOs, the information combines plan performance for the HMO and Point of Service (POS)* products for those HMOs that have both products. For PPOs, the information combines plan performance for all PPO and Exclusive Provider Organizations (EPO) for those PPOs that have both products.

This report contains information reported by the following HMO and PPO carriers:

  • Aetna - HMO/POS & PPO/EPO (Aetna Health Inc.; Aetna Life Insurance Company)
  • AmeriHealth - HMO/POS & PPO/EPO (AmeriHealth HMO, Inc.; AmeriHealth Insurance Company of New Jersey)
  • Cigna - PPO (Cigna HealthCare of New Jersey, Inc.; Cigna Health and Life Insurance Company)
  • Horizon - HMO & PPO/EPO (Horizon Healthcare of New Jersey, Inc.; Horizon Healthcare Services, Inc.)
  • Oxford - HMO/POS & United PPO/EPO (Oxford Health Plans (NJ), Inc.; Oxford Health Insurance, Inc.; UnitedHealthcare Insurance Company)

This report does not include performance for New Jersey Department of Human Services programs (NJ FamilyCare). (See Other Important Resources for ways you can obtain information on this program and others.)

This report uses a measurement system called HEDIS®, which was developed by the National Committee for Quality Assurance (NCQA). It includes measures collected and reported by the HMOs and PPOs. All measures are verified by independent auditors.

Reports through 2008 included ratings of member satisfaction with HMO services. You can find summary measures of customer satisfaction by visiting the NCQA's web site. (See Choosing Your HMO for more information.)

For information on contacting these and other New Jersey plans, see Contacting Your HMO and PPO

*A Point of Service (POS) plan has some of the qualities of HMO and PPO plans with benefit levels varying depending on whether care is received in or out of the carrier's network of providers.

HEDIS® is a registered trademark of the National Committee for Quality Assurance.

OPRA is a state law that was enacted to give the public greater access to government records maintained by public agencies in New Jersey.
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New Jersey Department of Banking and Insurance