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, non-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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