Why You Need to Ask, “Is this Health Plan Accredited?”

When an employer is looking to select a health plan, one of the first questions they ask should be, “Is this health plan accredited?”

Accredited Importance

While most plans are accredited—and the vast majority of these have NCQA Accreditation—one in four insured Americans receive care

Health Benefits Claim Form

from health plans that have not demonstrated compliance with NCQA’s rigorous standards.

Much more than a “rubber stamp,” NCQA Accreditation allows employers to answer some crucial questions. For example, are decisions about treatment evidence based and made with oversight from appropriate medical professionals? Are appeals resolved in a timely manner so care is provided when it’s needed? Does the plan’s network have enough primary care, behavioral healthcare and specialty care practitioners to give employees access to the care they need?

Accredited Transparency

Accreditation also demonstrates that the health plan is willing to share data on how it performs as it relates to the consumer experience and clinical standards. This data opens the door to information that can help employers and employees select high performing health plans. And there are differences in plan performance; for example, among 544 commercial health plans rated from 1–5 (5 is highest) in 20190:

  • Only 126 commercial health plans scored 4 or 5.
  • Only 5 health plans scored 5.
  • The most common score was 3.0–3.5—most plans have room to improve!
  • 22 plans had scores at 2.5 or lower.

Employers, take a moment to see how well your health plan(s) are performing. And sign up for our employer newsletter, which delivers the latest ideas in performance improvement.