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 measures.
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. Click
here for ways to contact the health plan
- 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.
Benefits
- Find out what types of benefits the plan offers by reviewing the
member handbook or calling the member services department.
- 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 may need.
- Find out what types of care or benefits the plan does not offer.
Cost
- Try to get an idea of how much you are likely to pay in premiums,
copayments, coinsurance and deductibles each year.
- 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 maximum).
- Find out if the plan places limits on the amount of benefits it will
pay (annual or lifetime maximum).
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Accreditation
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 the 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: www.urac.org.
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.
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