How to Find a Quality Health Insurance Policy

When it comes time to buy affordable health insurance, quality is just as important as price. You want to ensure that you are purchasing from a reputable company that has sound finances and a proven track record when it comes to customer service. Before committing to any health insurance purchase, vet the plan to ensure you are buying from a quality company that will provide coverage when you need it.

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1) Is the health plan accredited?

One of the best ways to determine a company's overall quality is to check its accreditation. Several independent organizations evaluate health plans and accredit those that have met quality standards.

Three of the major national accrediting organizations are:

  1. National Committee for Quality Assurance (NCQA): The NCQA offers six accreditation programs including those for health plans, wellness programs and disease management. Nationwide, approximately 70.5 percent of all health plan members are enrolled in a NCQA accredited policy. In addition to accreditation, the NCQA also issues health insurance report cards that can be found on its website.
  2. URAC: As the largest accrediting body in the United States, URAC reviews the business operations used by a health plan to ensure they meet national standards. The organization relies on a committee, which includes consumer advocates, health professionals and representatives of the insurance industry, to update its standards every three years.
  3. Accreditation Association for Ambulatory Health Care (AAAHC): The AAAHC maintains four accreditation programs including one for managed care organizations. The voluntary accreditation process looks at a number of core standards including patient rights, quality of care, infection prevention and governance. To become accredited by the AAAHC, health insurance companies must complete a self-assessment that is then reviewed by an expert surveyor.

2) Check the financial strength of health insurance companies

While large insurers with familiar names may be less likely to have financial concerns, some small companies may be at risk for insolvency. Before purchasing a policy from a company with an unfamiliar name, check to make sure it is financially sound.

Standard & Poor's provides an independent review and evaluation of the finances of approximately 3,000 insurance organizations. Consumers can search the Standard & Poor's financial strength ratings of these insurers online. Ratings range from "AAA" (very strong) to "CC" (extremely weak). Companies at the lower end of the scale may not be able to meet some of their financial obligations.

3) Contact your state's insurance department

Because insurance is regulated at the state level, the best place to check for a record of consumer complaints is with your state's insurance department or commission. While you may need to call the insurance office in some states for information, others have user-friendly websites that offer detailed ratings and complaint records online.

For example, the California Office of the Patient Advocate lists Quality Report Cards for health insurance on its site. These report cards not only rate how health insurance companies compare to national standards, but also how their members rate the service they receive.

The National Association of Insurance Commissioners (NAIC) provides links to all the state departments on its website. Consumers also have the option of calling 1-866-470-NAIC to be connected to their state insurance commission or department. While on the NAIC website, don't forget to check whether state enforcement action has been taken against the insurer you are considering.

The original article can be found at"How to find a quality health insurance policy"

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