The State of New Jersey, through the Department of Health and Senior Services, monitors the quality of care and services provided by HMOs and POS plans. The Department investigates consumers' complaints with the plans and conducts in-depth reviews of each plan. Plans are also required to obtain a quality audit by an independent review organization every three years. This requirement may be met through a quality review by one of the three accreditation organizations listed here or the New Jersey Peer Review Organization.
What is accreditation?
This booklet provides results on how health plans performed in certain areas that demonstrate quality. Accreditation is another way of evaluating quality. Accreditation assures consumers that an independent organization has checked whether the health plan has effective systems in place for ensuring high quality care. You can refer to the websites listed under the following accreditation organizations for more information.
American Accreditation HealthCare Commission/URAC is an independent, not-for-profit organization that originally focused on the accreditation of utilization review programs, but has since expanded its accreditation activities to include other aspects of managed care. AAHCC's web site is: www.urac.org.
Joint Commission on Accreditation of Healthcare Organizations (JCAHO) 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. JCAHO's website is: www.jcaho.org.
National Committee for Quality Assurance (NCQA) is an independent, not-for-profit organization that assesses and reports on the quality of care provided by managed care organizations nationally. NCQA's web site is: www.ncqa.org.
This booklet refers to the managed health care plans in New Jersey with a large commercial enrollment. They are listed below along with other health plans approved to provide services in New Jersey. All the plans provide coverage for people with private insurance, such as that obtained through an employer. Some plans are approved to offer Medicaid or Medicare coverage. Not all plans offer coverage in all counties. Call the health plan at the telephone number shown if you have additional questions.
For more information on Medicare programs available in New Jersey, call the Department of Health and Senior Services at (800) 792-8820 or visit Medicare's web site: www.medicare.gov. The New Jersey Department of Human Services can provide additional information on Medicaid programs at (800) 356-1561.
|Health Plan||Telephone Number|
|Aetna U.S. Healthcare-New Jersey a,b||(800) 323-9930|
|AMERICAID Community Care a||(800) 600-4441|
|American Preferred Provider Plan a||(800) 310-2777|
|AmeriHealth HMO, Inc. New Jersey a,b||(800) 877-9829|
|AtlantiCare Health Plan||(800) 272-5995|
|CIGNA HealthCare of New Jersey, Inc. b||(800) 345-9458|
|CIGNA HealthCare of Northern New Jersey, Inc.-CoMED HMO b||(800) 345-9458|
|First Option Health Plan of New Jersey a,b||(800) 535-3647|
|HealthPlans of America, NJ, Inc||(888) 700-4647|
|HIP Health Plan of New Jersey a,b||(800) 240-7524|
|Horizon Health Care of New Jersey, Inc.-HMO Blue a,b||(800) 355-BLUE|
|Liberty Health Plan, Inc a||(800) 399-0499|
|Managed Healthcare Systems of New Jersey, Inc. a||(800) 941-4647|
|NYLCare Health Plans of New Jersey, Inc. b||(800) 496-1700|
|Oxford Health Plans-New Jersey, Inc. b||(800) 444-6222|
|Physicians Health Services of New Jersey, Inc.||(800) 441-5741|
|Principal Health Care of Delaware-New Jersey||(800) 833-7423|
|Prudential HealthCare-New Jersey b||(800) 422-7399|
|QualMed Plans for Health, Inc. b||(800) 736-2096|
|United HealthCare of New Jersey, Inc. b||(800) 705-1691|
|University Health Plans, Inc. a||(800) 564-6847|
Types of coverage:
a health plan also provides Medicaid coverage
b health plan also provides Medicare coverage