³Ô¹ÏºÚÁÏ

March 2016

Dear Consumers:

We are pleased to present a combined Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) Performance Report for 2015.  The report contains information on the performance of ³Ô¹ÏºÚÁÏ’s HMOs and PPOs and how well these health plans deliver important health care services.

The report is designed to provide information to consumers and employers on the quality of ³Ô¹ÏºÚÁÏ’s HMO and PPO health plans and the available coverage. We believe that you will find this information useful when choosing health coverage for your family or business.

³Ô¹ÏºÚÁÏ is a leader in providing comprehensive, strong consumer and patient protections. We urge you to become familiar with these protections, which are explained in this report.

By providing you with this report, we strive to empower you to make the best health care choices for you, your family or your employees.

Richard J. Badolato
Acting Commissioner
Department of Banking and Insurance

This report was developed by the ³Ô¹ÏºÚÁÏ Department of Health. It issued the first HMO performance report in 1997 with the cooperation of an advisory group representing HMOs, health care purchasers, providers and consumers. The New Jersey Department of Banking and Insurance (DOBI) assumed responsibility for providing the HMO Performance Report from the ³Ô¹ÏºÚÁÏ Department of Health in August 2005. Regulatory matters concerning managed health care in the state are now at DOBI.

In 2014, DOBI expanded this report on health plan performance by including data for PPOs. DOBI has compiled a single performance report to show side-by-side results of HMOs and PPOs, making the publication more meaningful to employers, employees, and individual purchasers of health insurance. 

This report includes information on all commercial managed care products currently marketed in ³Ô¹ÏºÚÁÏ by HMOs or PPOs that had at least 2,000 members enrolled in these products in both 2013 and 2014. For HMOs, the information combines plan performance for the HMO and Point of Service (POS)* products for those HMOs that have both products. For PPOs, the information combines plan performance for all PPO and Exclusive Provider Organizations (EPO) for those PPOs that have both products.

This report contains information on the following HMO and PPO carriers:

• Aetna-HMO/POS & PPO/EPO (Aetna Health Inc. – a ³Ô¹ÏºÚÁÏ corporation; Aetna Life Insurance Company)
• AmeriHealth-HMO/POS & PPO/EPO (AmeriHealth HMO, Inc.; AmeriHealth Insurance Company of ³Ô¹ÏºÚÁÏ)
• Cigna-HMO/POS & PPO (Cigna HealthCare of ³Ô¹ÏºÚÁÏ, Inc.; Cigna Health and Life Insurance)
• Horizon-HMO & PPO/EPO (Horizon Healthcare Services, Inc.; Horizon BCBS of ³Ô¹ÏºÚÁÏ Inc.)
• United/Oxford-HMO/POS & PPO/EPO (Oxford Health Plans of ³Ô¹ÏºÚÁÏ; Oxford Health Insurance Company, Inc.; UnitedHealthcare Insurance Company)

This report does not include performance for ³Ô¹ÏºÚÁÏ Department of Human Services programs (NJ FamilyCare). (See Other Important Resources for ways you can obtain information on these programs.)

This report uses a measurement system called HEDIS®, which was developed by the National Committee for Quality Assurance (NCQA). It includes measures collected and reported by the HMOs and PPOs. All measures are verified by independent auditors.

Reports through 2008 included ratings of member satisfaction with HMO services. You can find summary measures of customer satisfaction by visiting the NCQA's web site. (See Choosing Your HMO for more information.)

For information on contacting these and other ³Ô¹ÏºÚÁÏ plans, see Contacting Your HMO and PPO

HEDIS® is a registered trademark of the National Committee for Quality Assurance.