Do health plan members have access to the care and services they need?


The "New Jersey Managed Health Care Plans: Compare Your Choices" 1998 report produced by the National Committee for Quality Assurance (NCQA) provides summary charts and details in bar graphs. The bar graphs include individual plan scores and the group average for each measure.

Provided by New Jersey Department of Health and Senior Services.


The scores show how each of the plans compares to the average for the New Jersey plans shown. Bar graphs following show scores for each plan on selected topics.

Summarized Results

Higher than average scores mean better performance.

Higher: Score for plan is above the average score for New Jersey plans. A dark circle indicates Higher.
Average: Score for plan is neither higher nor lower than the average score for New Jersey plans. A half dark and half white circle indicates Average.
Lower: Score for plan is below the average score for New Jersey plans. A white circle indicates Lower.


Health Maintenance Organizations (HMOs)

Aetna USHC HMO
Overall rating of the health plan: Higher
Ease of getting referrals to specialists: Average
Reasonableness of paperwork and payment: Average
Efficiency and helpfulness of health plan's customer service: Higher
Courtesy, respect and helpfulness of medical office staff: Average

AmeriHealth HMO
Overall rating of the health plan: Higher
Ease of getting referrals to specialists: Average
Reasonableness of paperwork and payment: Average
Efficiency and helpfulness of health plan's customer service: Higher
Courtesy, respect and helpfulness of medical office staff: Higher

CIGNA-Northern NJ HMO
Overall rating of the health plan: Average
Ease of getting referrals to specialists: Average
Reasonableness of paperwork and payment: Average
Efficiency and helpfulness of health plan's customer service: Average
Courtesy, respect and helpfulness of medical office staff: Average

CIGNA-Southern NJ HMO
Overall rating of the health plan: Average
Ease of getting referrals to specialists: Average
Reasonableness of paperwork and payment: Average
Efficiency and helpfulness of health plan's customer service: Average
Courtesy, respect and helpfulness of medical office staff: Average

First Option HMO
Overall rating of the health plan: Average
Ease of getting referrals to specialists: Average
Reasonableness of paperwork and payment: Higher
Efficiency and helpfulness of health plan's customer service: Average
Courtesy, respect and helpfulness of medical office staff: Average

HIP HMO
Overall rating of the health plan: Lower
Ease of getting referrals to specialists: Average
Reasonableness of paperwork and payment: Average
Efficiency and helpfulness of health plan's customer service: Lower
Courtesy, respect and helpfulness of medical office staff: :Lower

HMO Blue
Overall rating of the health plan: Average
Ease of getting referrals to specialists: Average
Reasonableness of paperwork and payment: Average
Efficiency and helpfulness of health plan's customer service: Average
Courtesy, respect and helpfulness of medical office staff: Average

NYLCare HMO
Overall rating of the health plan: Average
Ease of getting referrals to specialists: Average
Reasonableness of paperwork and payment: Average
Efficiency and helpfulness of health plan's customer service: Average
Courtesy, respect and helpfulness of medical office staff: Average

Oxford HMO
Overall rating of the health plan: Higher
Ease of getting referrals to specialists: Average
Reasonableness of paperwork and payment: Average
Efficiency and helpfulness of health plan's customer service: Average
Courtesy, respect and helpfulness of medical office staff: Average

PHS-NJ HMO
Overall rating of the health plan: Higher
Ease of getting referrals to specialists: Average
Reasonableness of paperwork and payment: Average
Efficiency and helpfulness of health plan's customer service: Higher
Courtesy, respect and helpfulness of medical office staff: Average

Prudential HMO
Overall rating of the health plan: Lower
Ease of getting referrals to specialists: Average
Reasonableness of paperwork and payment: Average
Efficiency and helpfulness of health plan's customer service: Lower
Courtesy, respect and helpfulness of medical office staff: Average

United HMO
Overall rating of the health plan: Average
Ease of getting referrals to specialists: Average
Reasonableness of paperwork and payment: Average
Efficiency and helpfulness of health plan's customer service: Average
Courtesy, respect and helpfulness of medical office staff: Lower


POS

Aetna USHC POS
Overall rating of the health plan: Average
Ease of getting referrals to specialists: Average
Reasonableness of paperwork and payment: Average
Efficiency and helpfulness of health plan's customer service: Average
Courtesy, respect and helpfulness of medical office staff: Average

AmeriHealth POS
Overall rating of the health plan: Higher
Ease of getting referrals to specialists: Average
Reasonableness of paperwork and payment: Average
Efficiency and helpfulness of health plan's customer service: Average
Courtesy, respect and helpfulness of medical office staff: Average

CIGNA-Northern NJ POS
Overall rating of the health plan: Lower
Ease of getting referrals to specialists: Average
Reasonableness of paperwork and payment: Lower
Efficiency and helpfulness of health plan's customer service: Lower
Courtesy, respect and helpfulness of medical office staff: Average

First Option POS
Overall rating of the health plan: Lower
Ease of getting referrals to specialists: Lower
Reasonableness of paperwork and payment: Average
Efficiency and helpfulness of health plan's customer service: Average
Courtesy, respect and helpfulness of medical office staff: Average

NYLCare POS
Overall rating of the health plan: Lower
Ease of getting referrals to specialists: Average
Reasonableness of paperwork and payment: Lower
Efficiency and helpfulness of health plan's customer service: Lower
Courtesy, respect and helpfulness of medical office staff: Average

Oxford POS
Overall rating of the health plan: Average
Ease of getting referrals to specialists: Higher
Reasonableness of paperwork and payment: Average
Efficiency and helpfulness of health plan's customer service: Average
Courtesy, respect and helpfulness of medical office staff: Higher

PHS-NJ POS
Overall rating of the health plan: Lower
Ease of getting referrals to specialists: Average
Reasonableness of paperwork and payment: Lower
Efficiency and helpfulness of health plan's customer service: Lower
Courtesy, respect and helpfulness of medical office staff: Average

United POS
Overall rating of the health plan: Average
Ease of getting referrals to specialists: Average
Reasonableness of paperwork and payment: Average
Efficiency and helpfulness of health plan's customer service: Average
Courtesy, respect and helpfulness of medical office staff: Average


Access and Services

Ease of getting referrals to specialists


This list shows the bar graph of health plan members responding "yes" to the following survey question:
"Was it always easy to get a referral when you needed one?"

Source: consumer survey.


Percent Who Said "Yes," It Was Easy To Get a Referral

New Jersey Plan Average 82%

Aetna USHC HMO 84%

AmeriHealth HMO 87%

CIGNA-Northern NJ HMO 82%

CIGNA-Southern NJ HMO 87%

First Option HMO 83%

HIP HMO 79%

HMO Blue 85%

NYLCare HMO 87%

Oxford HMO 85%

PHS-NJ HMO 79%

Prudential HMO 84%

United HMO 83%

Aetna USHC POS 85%

AmeriHealth POS 86%

CIGNA-Northern NJ POS 75%

First Option POS 72%

NYLCare POS 77%

Oxford POS 88%

PHS-NJ POS 76%

United POS 77%


Reasonableness of paperwork and payment


Health plan members were asked whether the number of forms they had to fill out was reasonable and whether the health plan handled approvals and payments without taking a lot of their own time and energy.

Source: consumer survey


Percent who said: never or sometimes, usually, always

New Jersey Plan Average

Never or sometimes 19%
Usually 11%
Always 69%

Aetna USHC HMO

Never or sometimes 19%
Usually 7%
Always 74%

AmeriHealth HMO

Never or sometimes 17%
Usually 8%
Always 74%

CIGNA-Northern NJ HMO

Never or sometimes 19%
Usually 11%
Always 70%

CIGNA-Southern NJ HMO

Never or sometimes 21%
Usually 12%
Always 67%

First Option HMO

Never or sometimes 16%
Usually 11%
Always 73%

HIP HMO

Never or sometimes 18%
Usually 8%
Always 74%

HMO Blue

Never or sometimes 17%
Usually 14%
Always 69%

NYLCare HMO

Never or sometimes 22%
Usually 9%
Always 68%

Oxford HMO

Never or sometimes 16%
Usually 11%
Always 73%

PHS-NJ HMO

Never or sometimes 21%
Usually 12%
Always 67%

Prudential HMO

Never or sometimes 20%
Usually 11%
Always 69%

United HMO

Never or sometimes 17%
Usually 12%
Always 71%

Aetna USHC POS

Never or sometimes 18%
Usually 12%
Always 70%

AmeriHealth POS

Never or sometimes 18%
Usually 10%
Always 73%

CIGNA-Northern NJ POS

Never or sometimes 23%
Usually 15%
Always 62%

First Option POS

Never or sometimes 19%
Usually 11%
Always 71%

NYLCare POS

Never or sometimes 23%
Usually 15%
Always 62%

Oxford POS

Never or sometimes 19%
Usually 8%
Always 73%

PHS-NJ POS

Never or sometimes 23%
Usually 14%
Always 63%

United POS

Never or sometimes 18%
Usually 16%
Always 66%


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