NCQA's Health Plan Report Card can show you how well health plans are doing the things they should be doing-from checking doctors' qualifications to ensuring access and delivering great service. Whether you are selecting a new health plan or are currently enrolled in one, the Health Plan Report Card can help.

To select a new health plan: If you're selecting a health plan for the first time or are considering switching to a new one, simply create a report card of the plans from which you can choose. If you have more than one health plan option available to you, compare each of their results to make a more informed decision. If only a single health plan is available to you, it's still good to know as much as you can about the quality that health plan provides.

If you're already enrolled in a health plan: Even if you are happy with your current health plan, it is important for you to know whether your plan measures up to NCQA's standards of quality and service. Create a report card with your present plan. If your current health plan is not accredited by NCQA, you may want to ask why. On average, plans that are not accredited by NCQA don't perform as well as accredited plans across many different aspects of care and service. If you receive your health insurance coverage through your employer, talk to your employer's benefits manager if your plan in not accredited by NCQA.

What the Results Mean

The accreditation outcome summarizes just how well the plan performs overall. Plans with higher levels of NCQA Accreditation can generally be expected to provide better care and service than plans with lower levels of accreditation, but any level of NCQA Accreditation is a good indication that a plan is committed to quality.

In some cases, more than one of the health plans you're comparing will have achieved the same level of accreditation. In this case, it's important to consider how each health plan's performance-indicated by the star ratings-match up with factors that are most important to you.

When looking at the results from the Health Plan Report Card, the first thing to consider is the plan type. NCQA has two accreditation programs for the different types of health plans:

Accreditation of MCO (HMOs and POS) plans

One accreditation program is for health plans known as HMOs and POS plans. To be accredited by NCQA these plans must meet a set of requirements that cover a full spectrum of services and clinical care. The individual requirements are organized into five categories:

Access and Service
Qualified Providers
Staying Healthy
Getting Better
Living with Illness

HMO and POS plans are eligible to receive up to four stars in each report card category.

Based on their overall performance, HMOs and POS plans are eligible to receive one of the following Accreditation outcomes

Excellent
Commendable
Accredited
Provisional
Denied

Accreditation of PPO plans

NCQA's also accredits PPOs. Compared to HMOs and POS plans, PPOs manage care in a different way. Therefore, NCQA's requirements for PPOs cover the following areas:

Access and Service
Qualified Providers

PPOs are eligible to receive up to three stars in each report card category.

Based on their overall performance, PPOs are eligible to receive one of the following Accreditation outcomes:

Full
One-Year
Accredited
Provisional
Denied

Your current health situation and your experience with the plans you are selecting among will determine which plan type and categories are most important to you.

Choosing Your Health Plan

Selecting a health plan to cover you and your family is one of the more important decisions most of us make every year. Before making that decision, you should get to know as much as possible about your health plan choices-What benefits and services do they cover? Is your doctor in the network? How does the plan work? How much will it cost?

welcome | create report card | using results | definitions | methods | participation/statistics | feedback | top

©National Committee for Quality Assurance - 1100 13th Street, NW, Suite 1000, Washington, DC 20005 - (202) 955-3500
contact Webmaster@ncqa.org