Methods

The health plan results shown in the Health Plan Report Card are based on NCQA Accreditation. At the health plan's request, NCQA sends a team of trained health care experts, including physicians, to conduct a rigorous, on-site review of the health plan. The expert reviewers evaluate core systems and processes of a plan. NCQA combines information from the on-site review with information from health plan records and consumer surveys. No one affiliated with the health plan is part of the review team or involved in making the accreditation decision.

For each organization included in NCQA's various report cards, a certain number of stars appear in each category which that organization was evaluated. These stars reflect how well an organization performed against the standards and/or measures in that category. HMOs are evaluated in the five categories of Access and Service, Qualified Providers, Staying Healthy, Getting Better and Living with Illness. For HMO/POS plans, 4 stars indicates the highest level of performance in a category. NCQA's requirements for PPOs covers performance in the categories of Access and Service and Qualified Providers. For PPO Plans, 3 stars indicates the highest level of performance. Health plans for which NCQA Denied, Suspended, or Revoked accreditation are not eligible to receive stars for any of the Report Card categories.

For HMO/POS plans, the Accreditation outcome and star ratings are based in part on HEDIS® measures.

PPO plans accredited by NCQA are evaluated by standards focused on the enrollee's experience, consumer protection and improvement in service to enrollees. NCQA does not include HEDIS performance data in PPO Accreditation.

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