RI 70-13

Revised November 1999

1999

Plan Satisfaction

Survey Results and

Benefit Information

United States Office of

Personnel Management

Retirement and

Insurance Service

Be sure to visit our web site at

www.opm.gov/insure

How Members Rated

Their FEHB Plans

(With benefit information and plan accreditations)
The U.S. Office of Personnel Management (OPM) administers the Federal Employees Health Benefits

(FEHB) Program, the largest employer-sponsored health insurance program in the world. We

interpret the health insurance laws and write regulations for the FEHB Program. We give advice and help

to agencies and retirement systems so they can process your enrollment changes and deduct your premium.

We also contract with and monitor your plan — and all the other health plans — that pay claims or

provide care to covered members.

This is our commitment to you:

 Your choice of health benefits plans will compare favorably for value and selection with the

private sector.

 When you use the FEHB Guide and plan benefit brochures, you will find they are clear, factual

and give you the information you need.

 When you change plans or options, your new plan will issue your identification card within 15

calendar days after it gets your enrollment form from your agency or retirement system.

 Your fee-for-service plan should pay your claims within 20 work days; if more information is

needed, it should pay within 60 calendar days.

 If you ask us to review a claim dispute with your plan, our decision will be fair and easy to

understand, and we will send it to you within 60 calendar days. If you need to do more before

we can review a claim dispute, we will tell you within 14 work days what you still need to do.

 When you write to us about other matters, we will respond within 30 calendar days after we

get your letter. If we need time to give you a complete response, we will let you know.

Our Commitment to Our Customers

Better Information

Better Choices

Better Health
Page

FEHB and You ....................................2

Quality Indicators

Satisfaction Survey ........................................ 4

Accreditation ............................................ 5

Plan Comparisions

Nationwide Fee-for-Service Plans Open to All ......................... 6

Nationwide Fee-for-Service Plans Open Only to Specific Groups .............. 8

Health Maintenance Organization Plans and

Plans Offering a Point of Service Product .......................... 10

Things to Remember

 A number of plans withdrew from the FEHB Program.

Make sure your plan will be offered in 2000

 Be aware of benefit changes for 2000

 Check the premium for 2000

The information in the 2000 Guide to Federal Employees Health Benefits (FEHB) Plans gives you

an overview of the FEHB Program and its participating plans. Do not make any final decisions

about health plans without first reading the plans’ brochures.

1

Table of Contents
The Federal Employees Health Benefits (FEHB)

Program can help you meet your health care

needs. Federal employees, retirees and their

survivors enjoy the widest selection of health plans

in the country. You can choose from among

Fee-for-Service (FFS) plans, regardless of where

you live, or Plans offering a Point of Service (POS)

product and Health Maintenance Organizations

(HMO) if you live (or sometimes if you work)

within the area serviced by the plan.

Some FFS plans are open to all enrollees, but some

require that you join the organization that sponsors

the plan. Some plans limit enrollment to certain

employee groups. Membership requirements and/or

limitations also apply to any POS product the FFS

plan may be offering.

Managed care is an important part of the FEHB

Program. You will find managed care features in all

the plans described in this Guide. Common features of managed care are pre-approval of hospital

stays, the use of primary care providers as “gatekeepers” to coordinate your medical care, and networks of physicians and other providers.

You are fortunate to be able to choose from among

many different health plans competing for your

business. Use this Guide to compare the costs, benefits, and features of different plans. We combined

the HMO and POS plans in a single section. We

also now show comparative benefit information for

all plans. The benefit categories we list were chosen based on enrollee requests, differences among

plans, and simplicity. However, we urge you to

consider the total benefit package, in addition to

service and cost, when choosing a health plan.

The plan brochures tell you what services and supplies are covered and the level of coverage. Look

over the brochures carefully, especially the Changes

page of your current plan to see how benefits have

changed from last year. The brochures reflect the

efforts of OPM and health plan representatives to

eliminate jargon and use plain language. We also

formatted the brochures to ensure they are all organized alike. You can get brochures from the health

plans or your human resource office. They are also

available on our web site at www.opm.gov/insure.

When it comes to your health care, the best surprise is no surprise.

Choosing a plan

Cost — certainly the premium you pay is an

important consideration, but there are some other

things you should consider. When thinking about

premiums, what can you afford biweekly or

monthly? Should you enroll in a High Option –

and pay High Option premiums – if a Standard

Option would do?

If you need to go to the hospital, how much will

you have to pay? Do you know how much you will

pay for an emergency room visit? If you have children, what will it cost you for a well-child care

visit?

Do you have to pay a deductible for the services

you might use? Your share of medical expenses is

either a coinsurance (a percentage of the bill) or a

copayment (a fixed dollar amount). Which option

do you prefer and what does the plan require? Does

the plan limit the dollar amount it will pay for certain services?

Coverage — check to see if the plan offers the

type of services you think you might need. If you

are 65 or over, how does the plan coordinate coverage with Medicare? If you regularly see an allergist,

do you pay extra for the allergy serum? Does the

plan offer a prenatal program? Given the trend

toward reducing hospital stays, will your plan pay

for home health care? Because health care is expensive, pay attention to the plan’s catastrophic coverage to see how you are protected. See if there are

limits on the number of visits for the services you

need.

How the plan works — if predictable cost,

comprehensive benefits, no paperwork, and a coordinated approach to health care are high priorities,

consider a Health Maintenance Organization

2

FEHB and You
(HMO). Most HMOs require you to select a doctor to act as your primary care physician, or PCP,

who refers you to specialists. If you don’t use a

plan doctor, the plan usually will not pay for the

services, unless it is an emergency.

A plan offering a Point of Service (POS) product

also has rules about what benefits are covered and

doctor choice and access to specialists, but you can

choose any doctor you like and see specialists without referrals if you agree to pay more.

If you are willing to pay a little more in total costs

for the widest choice of doctors, a Fee-for-Service

(FFS) plan might be for you. FFS plans let you

choose your own doctor and allow you to see specialists without a referral. Most FFS plans have Preferred Provider Organizations (PPO) that save you

money if you use these providers.

Some plans offer 24-hour medical advice lines to

help you make health decisions. These programs try

to keep you healthy and avoid unnecessary – and

potentially costly and time-consuming – medical

treatment.

Satisfaction — the experience of health plan

members form the satisfaction ratings in this

Guide. If you are considering joining a FFS plan,

chances are you will file a claim. How quickly does

the plan process claims? Will the plan be responsive to your questions? As an HMO enrollee, you

might be most interested in how the plan is rated

in access to care and choice of doctors. Ask your

doctor’s office about experiences with different

health plans.

Accreditations — HMO accreditations reflect

the evaluations of independent, nationally-recognized

organizations. Plans willing to go through an

accreditation review show a commitment to continuous quality improvement and accountability.

Getting the most from a plan

Within any plan, there are things you can do to

minimize your out-of-pocket costs and make the

plan work best for you.

Cost — here are some ideas for getting the best

value for your premium dollar:

 An easy way to save money is to use your

plan’s mail order drug program, if it has one.

 Request generic drugs instead of brand name

drugs.

 Almost all FFS Plans have Preferred Provider

Organizations (PPO). Using a PPO will

reduce your out-of-pocket expenses. If you

do not use a PPO provider, your plan will

base its payment on an allowance that probably will be less than the actual billed charge.

This means you have to pay the difference,

which may be more than the coinsurance

amounts stated in this Guide and the plan

brochure. You can reduce the chance of this

happening by discussing fees in advance with

your provider. Remember that plans set their

own allowances.

It is also important to note that all of the services

provided in a PPO hospital may not be covered by

PPO arrangements. Room and board will be covered, but the anesthesia and radiology services may

not be. The only way to find out is to ask ahead of

time.

Quality — talk openly with your health plan and

providers about the kind of quality you want. Is

your HMO rated by a national accrediting organization? Ask your surgeon how frequently he or she

performs the procedure you are considering. If you

are pregnant, ask your obstetrician the percentage

of cases in which he or she performs a caesarean

section and how that compares with the local

average. Is your doctor proposing an invasive

approach to treatment when a more conservative

one is just as effective? Does your doctor discuss

possible drug interactions when prescribing a new

medication for you?

No one has a greater stake in your health than you.

Understand how your plan works and don’t be shy

about asking questions. An informed consumer is a

better decision maker.

3

FEHB and You
What the survey asked health plan enrollees:

 Getting Needed Care. Did you have

problems getting a referral to a specialist?

Did you experience delays in obtaining care?

Did you have problems getting the care you

and your doctor believed necessary?

 Getting Care Quickly. When you called

during regular office hours, did you get the

advice or help you needed? Could you get an

appointment for regular or routine health care

as soon as you wanted?

 How Well Doctors Communicate.

Did the doctors or other health providers listen carefully to you? Did they explain things

in a way you could understand? Did they

spend enough time with you?

 Courteous and Helpful Office

Staff. Did the doctor or some other provider’s staff treat you with courtesy and

respect? Was the staff as helpful as you

thought they should be?

 Customer Service. Were you helped

when you called your plan’s customer service

department? Did you have problems with

paperwork for your plan? Was it hard to find

and understand information in the plan’s written materials?

 Claims Processing. Did your plan handle your claims in a reasonable time? Did

they handle your claims correctly?

 Overall Plan Satisfaction. How

would you rate your overall experience with

your health plan?

4

Quality Indicators

Satisfaction Survey

OPM and FEHB plans and enrollees participated this year in a broad-based survey effort with other public

and private employers by using the Consumer Assessment of Health Plans Survey. This survey is a widely

accepted tool for obtaining customer feedback on their experiences with their health plans. Before you join

a plan, it may help to know what people who use the plan say about it. The survey results are not provided or

influenced by the health plans; they are solely based on the responses of enrolled individuals like yourself. The complete questionnaire (59 questions) is on our web site at www.opm.gov/insure, but for ease of presentation

in this Guide we have summarized findings in the following key areas:

A plan may not be rated for one of three reasons: 1) it is new to the FEHB Program, 2) the plan has

fewer than 500 Federal subscribers, or 3) the plan failed to administer the survey as we asked. We have

identified the plans in this last category with an X.

FEHB plans also participated in a separate child’s survey, but this data was not available for publication at

the time this Guide went to print. Check our web site for results.

The Ratings. A plan’s numbers show how well the plan scored for each question. For overall satisfaction the highest value is a 1. The other scores are on a scale of 3 (highest) to 1 (lowest). The numbers atop

each category show the national average for the plan type (i.e., fee-for-service compared to fee-for-service

and HMO/POS compared to HMO/POS). For more information about individual plan ratings, visit our

web site at www.opm.gov/insure.
The National Committee for Quality Assurance

(NCQA) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

are independent, private, not-for-profit organizations dedicated to assessing and reporting on the

quality of health care organizations. These organizations are completely independent of the health

plans and issue their accreditation results without

the approval of the health plans they review. We

encourage all FEHB plans to get accreditation from

a national accrediting organization, who will evaluate their systems and processes and confer

accreditation much like educational accrediting

institutions confer accreditation to schools.

Quality includes 1) the perception of the quality of

care received and 2) the quality of medical care

provided. The first is measured by annual satisfaction surveys. The second is measured in part by

accreditation. As an employer, accreditation to us

means accountability to a customer and validation

of selected measures of a health plan’s operations.

Enrollees can be assured that an independent organization has performed an unbiased assessment of a

health plan’s systems and found them to be of a

particular quality. We think an accredited plan

offers value to your health plan decision making.

Note: There are various reasons why a plan is not

accredited; check with the plan for an explanation.

5

Quality Indicators

Accreditation

Accreditation is a rigorous and comprehensive evaluation process where independent organizations assess

the quality of the key systems and processes that managed care organizations (specifically, an HMO or POS

plan) use. Accreditation also includes an assessment of the care and service plans are delivering in important areas of public concern such as immunization rates, mammography rates, and member satisfaction.

Both NCQA and JCAHO have multiple levels of accreditation.

To find a plan’s specific level of accreditation, visit our web site

at www.opm.gov/insure.
Plan name

6

Alliance Health Plan 1R PPO $100* $200C* $150 $2,000*

Non-PPO $300* $200C* $250 $3,000*

APWU Health Plan◊ 47 PPO $250 $50L None $2,000

Non-PPO $250 $50L $200 $3,500

Blue Cross and Blue Shield-High 10 PPO $150 None None $1,000

Non-PPO $150 None $100 $2,700

Blue Cross and Blue Shield-Std◊ 10 PPO $200 None None $2,000

Non-PPO $200 None $250 $3,750

GEHA Benefit Plan◊ 31 PPO $300 None None $2,500

Non-PPO $300 None None $3,500

Mail Handlers-High 45 PPO $150 $250C* None $2,500

Non-PPO $150 $250C* $250 $4,000

Mail Handlers-Std 45 PPO $200 $600C* $150 $4,000

Non-PPO $200 $600C* $300 $4,000

NALC 32 PPO $275 $25L None $3,000

Non-PPO $275 $25L $100 $3,500

Postmasters-High 36 PPO $200 $50 None $2,500

Non-PPO $275 $100 $150 $2,500

Postmasters-Std 36 PPO $200 $50 None $3,000

Non-PPO $350 $100 $250 $4,500

Benefit

type

Medical-Surgical — You pay

Deductible

Catastrophic

Per Person Per Stay Limit

Hospital

Calendar Prescription Inpatient

Year Drug

Plan

code

Nationwide Fee-for-Service Plans Open to All

How to read this chart:

The table below highlights selected features that may help you narrow your choice of health plans. An (*) in any column means an

exception to the general rule for that particular plan and we have tried to explain those exceptions here under the applicable column

heading. 

The Deductibles shown are the amount of covered expenses that you pay before your health plan begins to pay. 

Calendar Year deductibles for families are usually several times the amount shown for individuals and the entire family collectively

contributes towards that amount. However, some plans require 3 family members to meet the per person deductible before the family deductible is considered met (*).

Some plans apply Prescription Drug purchases to the Calendar Year deductible (CY). Some plans apply a separate deductible to

the combined purchase of mail order drugs and drugs from local pharmacies (C), while others apply it to drugs purchased from local

pharmacies only (L). Some plans (*) require each family member to meet a per person deductible.

The Per Stay Hospital Inpatient deductible is what you pay each time you are admitted to a hospital.

◊ Offers a Point of Service product.
Medical-Surgical — You pay

Coinsurance (%)/Copay ($)

Mail Order 

Hospital Prescription

Drugs

Outpatient Inpatient Outpatient Doctors Tests R&B Other Other Generic Brand

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all FFS plans shown in heading)

Overall plansatisfaction(.82)Getting neededcare (2.85)Getting carequickly (2.53)How well doctorscommunicate(2.50)Courteous andhelpful officestaff (2.63)Customer service (2.50)Claims processing(2.39)

7

10% 10% 10% 10% 10% 20% 20% 0.85 2.88 2.60 2.55 2.73 2.45 2.44 30% 30% 30% 30% 30% 20% 20%

10% 10% 10% 10% 10% $7 $25 0.74 2.81 2.50 2.47 2.59 2.37 2.26 30% 30% 30% 30% 30% $7 $25

5% 5% Nothing Nothing $10 $8 $14 0.77 2.85 2.40 2.45 2.54 2.43 2.36 20% 20% 30% 30% $100/d $8 $14

10% 10% Nothing Nothing $25 $12 $20 0.77 2.85 2.40 2.45 2.54 2.43 2.36 25% 25% 30% 30% $150/d $12 $20

10% 10% Nothing 10% 10% $10 $30 0.88 2.85 2.54 2.50 2.64 2.64 2.54 25% 25% Nothing 25% 25% $10 $30

10% 10% Nothing Nothing 10% $10 $30 0.77 2.83 2.46 2.42 2.58 2.47 2.26 30% 30% Nothing Nothing 30% $10 $45

10% 10% Nothing Nothing 10% $10 $40 0.77 2.83 2.46 2.42 2.58 2.47 2.26 30% 30% Nothing Nothing 30% $10 $55

15% 15% Nothing Nothing 15% $12 $25 0.70 2.77 2.52 2.48 2.64 2.40 2.26 30% 30% 20% 20% 30% $12 $25

10% 10% Nothing Nothing 10% $5 $12 0.84 2.87 2.60 2.57 2.71 2.42 2.42 15% 20% Nothing 15% 20% $5 $12

10% 10% Nothing Nothing 10% $10 $20 0.84 2.87 2.60 2.57 2.71 2.42 2.42 30% 30% 30% 30% 30% $10 $20

The Catastrophic Limit is the maximum amount of certain covered charges the plan will require you to pay during the year. Some

plans (*) require each family member to meet the limit.

What you pay for Doctors inpatient visits and for surgical services is shown. 

Your share of Outpatient Tests — provided, or ordered, and billed by a physician or physicians’ group — is shown.

Your share of Hospital Inpatient Room and Board and Other covered charges (e.g., nursing, supplies, and medications) are shown,

usually after any per stay deductible. Services provided and billed by the hospital outpatient department (other than surgery) are

shown as Hospital Outpatient Other expenses.

Finally, what you pay for Generic and Brand name drugs purchased through Mail Order is shown.

Taken together, you can use the highlighted features to compare the richness of plan benefits, but always consult plan brochures

before making your final decision.

Satisfaction Indicators — See page 6 for a description of these results.
Plan name

8

Association Benefit Plan 42 PPO $250 CY None $2,000

Non-PPO $250 CY $100 $3,000

Foreign Service 40 PPO $250 None None $2,500

Non-PPO $250 CY $175 $2,500

Panama Canal Area 43 No PPO None $400L $125 $1,000 

Rural Carrier Benefit Plan 38 PPO $250 CY None $2,000

Non-PPO $250 CY $200* $2,500

SAMBA 44 PPO $300 None $200 $1,500

Non-PPO $300 None $200 $1,500

Secret Service Y7 No PPO $200 None $100 $1,000

Benefit

type

Medical-Surgical — You pay

Deductible

Catastrophic

Per Person Per Stay Limit

Hospital

Calendar Prescription Inpatient

Year Drug

Plan

code

Nationwide Fee-for-Service Plans Open Only to Specific Groups

How to read this chart:

The table below highlights selected features that may help you narrow your choice of health plans. An (*) in any column means an

exception to the general rule for that particular plan and we have tried to explain those exceptions here under the applicable column

heading. 

The Deductibles shown are the amount of covered expenses that you pay before your health plan begins to pay. 

Calendar Year deductibles for families are usually several times the amount shown for individuals and the entire family collectively

contributes towards that amount. However, some plans require 3 family members to meet the per person deductible before the family deductible is considered met (*).

Some plans apply Prescription Drug purchases to the Calendar Year deductible (CY). Some plans apply a separate deductible to

drugs purchased from local pharmacies only (L).

The Per Stay Hospital Inpatient deductible is what you pay each time you are admitted to a hospital.

† See your Personnel Office.
Medical-Surgical — You pay

Coinsurance (%)/Copay ($)

Mail Order 

Hospital Prescription

Drugs

Outpatient Inpatient Outpatient Doctors Tests R&B Other Other Generic Brand

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all FFS plans shown in heading)

Overall plansatisfaction(.82)Getting neededcare (2.85)Getting carequickly (2.53)How well doctorscommunicate(2.50)Courteous andhelpful officestaff (2.63)Customer service (2.50)Claims processing(2.39)

9

10% 10% Nothing Nothing 10% $10 $10 0.88 2.92 2.58 2.52 2.66 2.62 2.50 20% 20% 20% 20% 20% $10 $20

10% 10% Nothing 10% 10% $15 $25 0.83 2.88 2.55 2.52 2.67 2.49 2.30 20% 20% 20% 15% 20% N/A N/A

Nothing Nothing Nothing 20% 25% N/A N/A

15% 15% Nothing Nothing 15% $10 $15 0.88 2.93 2.63 2.54 2.78 2.63 2.57 15% 25% $200* 20% 25% $10 $15

10% 10% Nothing 10% 10% $15 $15 0.82 2.73 2.44 2.46 2.56 2.45 2.35 30% 30% 30% 30% 30% $15 $15

20% 20% Nothing Nothing Nothing $5 $12 XX X X X X X

The Catastrophic Limit is the maximum amount of certain covered charges the plan will require you to pay during the year. 

What you pay for Doctors inpatient visits and for surgical services is shown. 

Your share of Outpatient Tests — provided, or ordered, and billed by a physician or physicians’ group — is shown.

Your share of Hospital Inpatient Room and Board and Other covered charges (e.g., nursing, supplies, and medications) are shown,

usually after any per stay deductible. Some plans require this for your first admissions only (*). Services provided and billed by the

hospital outpatient department (other than surgery) are shown as Hospital Outpatient Other expenses.

Finally, what you pay for Generic and Brand name drugs purchased through Mail Order is shown.

Taken together, you can use the highlighted features to compare the richness of plan benefits, but always consult plan brochures

before making your final decision.

Satisfaction Indicators — See page 6 for a description of these results. An (X) means the plan did not conduct the survey as we

asked.
Primary care doctor

office copayHospital roomcopay/coinsurancePrescription drugs,genericPrescription drugs,brand

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all HMO/POS plans shown in heading)

10

Plan name

Plan

code

Overall plansatisfaction (.74)Getting needed care (2.66)Getting care quickly (2.39)How well doctorscommunicate (2.46)Courteous and helpful office staff (2.55)Customer service (2.44)Claims processing (2.22)Accreditation statusNCQA (N) JCAHO (J)

Alabama

Health Partners of Alabama DF $15 Nothing $5 $15 0.82 2.67 2.40 2.50 2.59 2.57 2.38

PrimeHealth of Alabama, Inc. AA $10 Nothing $10 $10 0.72 2.67 2.37 2.56 2.65 2.37 2.98

Arizona 

Aetna U.S. Healthcare WQ $10 Nothing $5 $10 0.68 2.62 2.27 2.32 2.42 2.44 2.12 N

CIGNA HC of AZ-Phoenix 16 $10 Nothing $5 $10 0.72 2.62 2.27 2.24 2.44 2.46 2.30 N

Health Plan of Nevada - In-Network NM $10 Nothing $6 $12 0.64 2.39 2.17 2.25 2.35 2.24 2.13

- Out-of-Network 20% 20% $6 $12

United Healthcare of Arizona 2S $10 Nothing $5 $10 0.74 2.59 2.32 2.43 2.49 2.52 2.29 N

United Healthcare of Arizona TD $10 Nothing $5 $10 0.76 2.66 2.21 2.40 2.48 2.59 2.47 N

Humana Health Plan of AZ DY $10 Nothing $5 $10 0.69 2.52 2.32 2.43 2.52 2.33 2.24

Intergroup of Arizona, Inc. A7 $10 Nothing $5 $10 0.65 2.45 2.14 2.26 2.37 2.39 2.22 N

PacifiCare of Arizona A3 $10 Nothing $5 $5 0.67 2.50 2.26 2.34 2.46 2.28 2.38 N

Premier HealthCare of Arizona 9A $10 Nothing $5 $10 0.74 2.56 2.44 2.52 2.68 2.38 2.11

Premier HealthCare of Arizona 9B $10 Nothing $5 $10 0.74 2.56 2.44 2.52 2.68 2.38 2.11

Arkansas 

QCA Health Plan - In-Network 8Q $10 Nothing $7 $15

- Out-of-Network 20% 20% $7 $15

Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State

How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans.

Primary Care Doctor Office shows what you pay for each

office visit to your primary care doctor. A (*) means a POS plan

pays non-plan doctors based on a fee schedule.

Hospital Room Copay/Coinsurance is your share of hospital room and

board charges. This is separate from any per admission deductible. A (*)

means a POS plan pays non-plan hospitals based on a fee schedule.
Primary care doctor

office copayHospital roomcopay/coinsurancePrescription drugs,genericPrescription drugs,brand

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all HMO/POS plans shown in heading)

11

Plan name

Plan

code

Overall plansatisfaction (.74)Getting needed care (2.66)Getting care quickly (2.39)How well doctorscommunicate (2.46)Courteous and helpful office staff (2.55)Customer service (2.44)Claims processing (2.22)Accreditation statusNCQA (N) JCAHO (J)

California 

Aetna U.S. Healthcare 2X $10 Nothing $5 $10 0.67 2.52 2.20 2.37 2.43 2.35 2.10

Aetna U.S. Healthcare BU $10 Nothing $5 $10 0.65 2.53 2.35 2.37 2.45 2.26 2.90 N

Blue Shield of CA Access+HMO SJ $10 Nothing $6 $6 0.64 2.64 2.36 2.60 2.54 2.28 1.89 N

Blue Cross CaliforniaCare M5 $10 Nothing $5 $10 0.69 2.53 2.21 2.28 2.43 2.33 2.43 N

CIGNA HealthCare of California 9T $10 Nothing $5 $10 0.65 2.48 2.19 2.28 2.33 2.30 2.16 N

Health Net LB $10 Nothing $5 $10 0.72 2.59 2.35 2.35 2.48 2.35 2.27 N

Kaiser Permanente 59 $10 Nothing $5 $5 0.76 2.69 2.34 2.35 2.50 2.46 2.00 N

Kaiser Permanente 62 $10 Nothing $5 $5 0.87 2.74 2.32 2.40 2.58 2.50 2.12 N

Maxicare Southern California CM $10 Nothing $5 $10 0.69 2.47 2.18 2.32 2.41 2.37 2.85

National HMO Health Plan MN $10 Nothing $5 $10

PacifiCare of California CY $10 Nothing $5 $10 0.71 2.51 2.24 2.34 2.44 2.44 2.31 N

United Health Plan C4 $10 Nothing $5 $5 J,N

Universal Care 6Q $10 Nothing $5 $5

Western Health Advantage 5Z $10 Nothing $5 $10

Colorado 

Aetna U.S. Healthcare 6F $10 Nothing $5 $10 0.61 2.58 2.38 2.44 2.58 2.21 1.91

CIGNA HealthCare of CO 1C $10 Nothing $10 $20 N

HMO Colorado/Nevada - In-Network L2 $10 Nothing $5 $15 0.64 2.55 2.39 2.46 2.49 2.27 2.14 N

- Out-of-Network 30% 30% N/A N/A

Kaiser Permanente 65 $10 Nothing $5 $5 0.74 2.64 2.34 2.42 2.54 2.45 2.23 N

PacifiCare of Colorado-High D6 $10 Nothing $5 $10 0.72 2.58 2.38 2.42 2.52 2.43 2.32 N

PacifiCare of Colorado-Std D6 $15 Nothing $10 $20 0.72 2.58 2.38 2.42 2.52 2.43 2.32 N

Rocky Mountain HMO 88 $10 Nothing $10 $15 0.78 2.78 2.57 2.51 2.61 2.50 2.39 N

Prescription Drugs, Generic, Brand shows what you pay for prescriptions when

you use a plan pharmacy. Some plans charge different amounts for refills (*), select

drugs and mail orders. In many plans, if you get the brand name instead of a generic

substitution, you also pay the difference between the two. Where a copay/coinsurance

are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. 

Satisfaction Indicators — See page 7 for a description

of these results. An (X) means the plan did not conduct

the survey as we asked.

Accreditation status — N = National Committee for

Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations
Primary care doctor

office copayHospital roomcopay/coinsurancePrescription drugs,genericPrescription drugs,brand

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all HMO/POS plans shown in heading)

12

Plan name

Plan

code

Overall plansatisfaction (.74)Getting needed care (2.66)Getting care quickly (2.39)How well doctorscommunicate (2.46)Courteous and helpful office staff (2.55)Customer service (2.44)Claims processing (2.22)Accreditation statusNCQA (N) JCAHO (J)

Connecticut 

Aetna U.S. Healthcare H1 $10 Nothing $5 $10 0.63 2.61 2.45 2.48 2.54 2.26 1.94 N

Blue Cross and - In-Network 10 $10 Nothing $5 $15 0.77 2.77 2.59 2.50 2.57 2.48 2.34 N

Blue Shield-Std - Out-of-Network 25% 30% 45% 45%

ConnectiCare TE $10 Nothing $10 $10 0.83 2.78 2.54 2.56 2.65 2.50 2.45 N

Harvard Pilgrim Health Care 68 $10 Nothing $5 $15 0.82 2.78 2.45 2.55 2.64 2.47 2.27 N

Health New England DJ $10 Nothing $7 $15 0.90 2.79 2.41 2.49 2.54 2.78 2.57 N

Physicians Health Services/CT DP $10 Nothing $10 $20 0.76 2.73 2.42 2.50 2.53 2.25 2.12 N

Delaware 

Aetna U.S. Healthcare NK $10 Nothing $5 $10

District of Columbia 

Aetna U.S. Healthcare-High JN $10 Nothing $5 $10 0.76 2.63 2.33 2.41 2.47 2.42 2.23 N

Aetna U.S. Healthcare-Std JN $15 Nothing $10 $15 0.76 2.63 2.33 2.41 2.47 2.42 2.23 N

CapitalCare 2G $10 Nothing $5 $10 0.75 2.59 2.37 2.45 2.58 2.42 2.32 N

Free State Health Plan - In-Network LD $10 Nothing $10 $20 0.74 2.69 2.38 2.53 2.56 2.43 2.25 N

- Out-of-Network 20% 20% $10 $20

George Washington Univ HP E5 $10 Nothing $5 $15 0.69 2.66 2.29 2.39 2.36 2.22 2.64 N

Kaiser Permanente E3 $10 Nothing $7 $7 0.78 2.63 2.35 2.36 2.55 2.50 2.76 N

MD-IPA JP $10 Nothing $5 $10 0.74 2.65 2.42 2.46 2.56 2.53 2.33 N

Prudential HealthCare HMO JB $10 Nothing $5 $15 0.69 2.65 2.38 2.46 2.58 2.23 1.89 N

Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State

How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans.

Primary Care Doctor Office shows what you pay for each

office visit to your primary care doctor. A (*) means a POS plan

pays non-plan doctors based on a fee schedule.

Hospital Room Copay/Coinsurance is your share of hospital room and

board charges. This is separate from any per admission deductible. A (*)

means a POS plan pays non-plan hospitals based on a fee schedule.
Primary care doctor

office copayHospital roomcopay/coinsurancePrescription drugs,genericPrescription drugs,brand

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all HMO/POS plans shown in heading)

13

Plan name

Plan

code

Overall plansatisfaction (.74)Getting needed care (2.66)Getting care quickly (2.39)How well doctorscommunicate (2.46)Courteous and helpful office staff (2.55)Customer service (2.44)Claims processing (2.22)Accreditation statusNCQA (N) JCAHO (J)

Florida 

Av-Med Health Plan EM $10 Nothing $5 $5 0.78 2.59 2.18 2.39 2.44 2.56 2.45 J,N

Av-Med Health Plan GP $10 Nothing $5 $5 0.73 2.54 2.19 2.36 2.43 2.37 2.19 J,N

Av-Med Health Plan H5 $10 Nothing $5 $5 0.78 2.64 2.37 2.46 2.52 2.48 2.40 J,N

Av-Med Health Plan HW $10 Nothing $5 $5 0.80 2.63 2.37 2.59 2.53 2.45 2.42 J,N

Av-Med Health Plan JF $10 Nothing $5 $5 0.77 2.66 2.38 2.49 2.58 2.47 2.32 J,N

Beacon Health Plan 4K $10 Nothing $5 $15

Capital Health Plan EA $10 Nothing $7 $20 0.89 2.79 2.44 2.45 2.67 2.64 2.72 N

Foundation Health 5C $10 Nothing $5 $5 0.67 2.52 2.21 2.34 2.40 2.24 2.15 N

Foundation Health 5D $10 Nothing $5 $5 0.67 2.52 2.21 2.34 2.40 2.24 2.15 N

Foundation Health 5E $10 Nothing $5 $5 0.67 2.52 2.21 2.34 2.40 2.24 2.15 N

HIP Health Plan of FL 3N $10 Nothing $5 $10 0.73 2.60 2.24 2.35 2.45 2.47 2.16 N

HIP Health Plan of FL K7 $10 Nothing $5 $10 0.73 2.60 2.24 2.35 2.45 2.47 2.16 N

Humana Medical Plan 7F $10 Nothing $5 $10 0.67 2.52 2.23 2.36 2.43 2.26 2.21 N

Humana Medical Plan 9D $10 Nothing $5 $10

Humana Medical Plan EE $10 Nothing $5 $10 0.68 2.53 2.20 2.34 2.39 2.25 2.28 N

Humana Medical Plan JH $10 Nothing $5 $10 0.63 2.47 2.15 2.32 2.42 2.27 2.22 N

Humana Medical Plan P5 $10 Nothing $5 $10 0.64 2.50 2.30 2.45 2.49 2.25 2.27 N

Humana Medical Plan P7 $10 Nothing $5 $10 0.67 2.52 2.23 2.36 2.43 2.26 2.21 N

Prudential HealthCare HMO EC $10 Nothing $5 $10 0.73 2.68 2.39 2.52 2.55 2.30 2.17 N

Prudential HealthCare HMO EH $10 Nothing $5 $10 0.66 2.67 2.26 2.42 2.43 2.37 2.21 N

Prudential HealthCare HMO HE $10 Nothing $5 $10 0.67 2.62 2.19 2.30 2.35 2.38 2.54 N

Total Health Choice 4A $10 Nothing $5 $15

United HealthCare of Florida QK $10 Nothing $10 $10 0.72 2.67 2.34 2.38 2.43 2.36 2.19

Prescription Drugs, Generic, Brand shows what you pay for prescriptions when

you use a plan pharmacy. Some plans charge different amounts for refills (*), select

drugs and mail orders. In many plans, if you get the brand name instead of a generic

substitution, you also pay the difference between the two. Where a copay/coinsurance

are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. 

Satisfaction Indicators — See page 7 for a description

of these results. An (X) means the plan did not conduct

the survey as we asked.

Accreditation status — N = National Committee for

Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations
Primary care doctor

office copayHospital roomcopay/coinsurancePrescription drugs,genericPrescription drugs,brand

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all HMO/POS plans shown in heading)

14

Plan name

Plan

code

Overall plansatisfaction (.74)Getting needed care (2.66)Getting care quickly (2.39)How well doctorscommunicate (2.46)Courteous and helpful office staff (2.55)Customer service (2.44)Claims processing (2.22)Accreditation statusNCQA (N) JCAHO (J)

Georgia

Aetna U.S. Healthcare 2U $10 Nothing $5 $10 0.66 2.58 2.33 2.45 2.56 2.27 1.87

Athens Area Health Plan Select 8Y $10 Nothing $5 $10

Blue Cross and - In-Network 10 $10 Nothing $5 $15 0.69 2.63 2.33 2.45 2.52 2.38 2.22 N

Blue Shield-Std - Out-of-Network 25% 30% 45% 45%

Kaiser Permanente F8 $10 Nothing $11 $11 0.84 2.68 2.44 2.48 2.62 2.55 2.13 N

Prudential HealthCare HMO EZ $10 Nothing $5 $15 0.65 2.65 2.18 2.38 2.36 2.28 2.12 N

Guam 

Guam Memorial Health Plan-High ZA $10 Nothing $5/20% $5/20% 0.82 2.75 2.36 2.63 2.66 2.45 2.21

Guam Memorial Health Plan-Std ZA $12 20% $10/20% $10/20% 0.82 2.75 2.36 2.63 2.66 2.45 2.21

PacifiCare Asia Pacific-High JK $10 Nothing $5 $5 0.71 2.54 2.12 2.35 2.36 2.33 1.89

PacifiCare Asia Pacific-Std JK $15 Nothing $5 $5 0.71 2.54 2.12 2.35 2.36 2.33 1.89

Hawaii 

HMSA - In-Network 87 20% Nothing $5 $10 0.89 2.92 2.69 2.64 2.75 2.60 2.54

- Out-of-Network 30% Nothing $5# $10#

Kaiser Permanente-High 63 $10 Nothing $7 $7 0.88 2.77 2.59 2.59 2.67 2.61 2.34 N

Kaiser Permanente-Std 63 $15 10% $7 $7 0.88 2.77 2.59 2.59 2.67 2.61 2.34 N

Idaho

Group Health Cooperative VR $10 Nothing $7 $7 0.79 2.74 2.49 2.57 2.66 2.55 2.47 N

Premera HealthPlus 8F $10 Nothing $5 $10 X X X X XX X

Illinois

Aetna U.S. Healthcare 6T $10 Nothing $5 $10

Aetna U.S. Healthcare XC $10 Nothing $5 $10 0.62 2.57 2.37 2.45 2.45 2.37 1.81 N

American HMO AC $10 Nothing $5 $10 0.56 2.60 2.45 2.43 2.51 2.86 1.83

Group Health Plan MM $10 Nothing $7 $12 0.72 2.62 2.38 2.44 2.53 2.28 2.89 N

Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State

How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans.

Primary Care Doctor Office shows what you pay for each

office visit to your primary care doctor. A (*) means a POS plan

pays non-plan doctors based on a fee schedule.

Hospital Room Copay/Coinsurance is your share of hospital room and

board charges. This is separate from any per admission deductible. A (*)

means a POS plan pays non-plan hospitals based on a fee schedule.
Primary care doctor

office copayHospital roomcopay/coinsurancePrescription drugs,genericPrescription drugs,brand

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all HMO/POS plans shown in heading)

15

Plan name

Plan

code

Overall plansatisfaction (.74)Getting needed care (2.66)Getting care quickly (2.39)How well doctorscommunicate (2.46)Courteous and helpful office staff (2.55)Customer service (2.44)Claims processing (2.22)Accreditation statusNCQA (N) JCAHO (J)

Illinois (continued)

Health Alliance HMO FX $10 Nothing $7 $14 0.83 2.75 2.57 2.55 2.65 2.52 2.39

Health Partners of the Midwest RN $10 Nothing $7 $12

Humana Health Plan Inc. 75 $10 Nothing $3 $7 0.66 2.60 2.27 2.37 2.41 2.24 2.25 N

John Deere Health Plan 3J $10 Nothing $5 $15 0.82 2.65 2.56 2.40 2.54 2.43 2.35

Mercy Health - In-Network 7M $10 Nothing $7 $12

Plans/Premier - Out-of-Network 30% 30% $7 $12

OSF HealthPlans 9F $10 Nothing $7 $15

PersonalCare’s HMO GE $10 Nothing $5 $10 0.86 2.80 2.54 2.48 2.64 2.57 2.49 N

Prudential HealthCare HMO VZ $10 Nothing $5 $15 0.68 2.68 2.47 2.46 2.60 2.27 2.38 N

Rush Prudential HMO 17 $10 Nothing $5 $5 0.65 2.52 2.28 2.41 2.48 2.25 1.86 N

Union Health Service 76 $10 Nothing $5 $5

Indiana 

Aetna U.S. Healthcare RD $10 Nothing $5 $10 0.62 2.57 2.45 2.49 2.56 2.28 1.84

Aetna U.S. Healthcare XC $10 Nothing $5 $10 0.62 2.57 2.37 2.45 2.45 2.37 1.81 N

American HMO AC $10 Nothing $5 $10 0.56 2.60 2.45 2.43 2.51 2.86 1.83

Arnett HMO G2 $10 Nothing $5 $15 0.83 2.77 2.49 2.49 2.62 2.59 2.52

Health Alliance HMO FX $10 Nothing $7 $14 0.83 2.75 2.57 2.55 2.65 2.52 2.39

Humana Care Plan 18 $10 Nothing $5 $10 0.70 2.70 2.31 2.44 2.54 2.32 2.97

Humana Health Plan D2 $10 Nothing $5 $10 0.72 2.62 2.39 2.47 2.55 2.32 2.17

Humana Health Plan Inc. 75 $10 Nothing $3 $7 0.66 2.60 2.27 2.37 2.41 2.24 2.25

Maxicare Indiana GK $10 Nothing $5 $10 0.66 2.65 2.42 2.44 2.57 2.30 2.28 N

PARTNERS Nat’l HPs of IN MC $10 Nothing $4 $7.50 N

Physicians HP of N. Indiana DQ $10 Nothing $10 $10

Prudential HealthCare HMO Midwest S3 $10 Nothing $5 $15 0.66 2.65 2.40 2.38 2.49 2.24 1.91 N

Rush Prudential HMO 17 $10 Nothing $5 $5 0.65 2.52 2.28 2.41 2.48 2.25 1.86 N

The M•Plan IN $10 Nothing $5 $10 0.77 2.66 2.47 2.47 2.57 2.43 2.18 N

Welborn HMO H3 $10 Nothing $5 $15 0.90 2.86 2.61 2.52 2.70 2.67 2.65 N

Prescription Drugs, Generic, Brand shows what you pay for prescriptions when

you use a plan pharmacy. Some plans charge different amounts for refills (*), select

drugs and mail orders. In many plans, if you get the brand name instead of a generic

substitution, you also pay the difference between the two. Where a copay/coinsurance

are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. 

Satisfaction Indicators — See page 7 for a description

of these results. An (X) means the plan did not conduct

the survey as we asked.

Accreditation status — N = National Committee for

Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations
Primary care doctor

office copayHospital roomcopay/coinsurancePrescription drugs,genericPrescription drugs,brand

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all HMO/POS plans shown in heading)

16

Plan name

Plan

code

Overall plansatisfaction (.74)Getting needed care (2.66)Getting care quickly (2.39)How well doctorscommunicate (2.46)Courteous and helpful office staff (2.55)Customer service (2.44)Claims processing (2.22)Accreditation statusNCQA (N) JCAHO (J)

Iowa 

Care Choices FA $10 Nothing $5 $5 X X X X XX X

Health Alliance HMO 7X $10 Nothing $7 $14 0.83 2.75 2.57 2.55 2.65 2.52 2.39

John Deere Health Plan 3J $10 Nothing $5 $15 0.82 2.65 2.56 2.40 2.54 2.43 2.35

Principal Health Care of Iowa SV $10 Nothing $5/25% $5/25% 0.75 2.69 2.48 2.38 2.51 2.45 2.36 N

SecureCare of Iowa 3Q $10 Nothing 25% 25%

Kansas 

Aetna U.S. Healthcare 7K $10 Nothing $5 $10

Blue Cross and - In-Network 10 $10 Nothing $5 $15 0.75 2.73 2.50 2.47 2.58 2.44 2.43

Blue Shield-Std - Out-of-Network 25% 30% 45% 45%

Humana Kansas City, Inc.-High MS $10 Nothing $5 $10 N

Humana Kansas City, Inc.-Std MS $15 Nothing $10 $20 N

Kaiser Permanente HA $10 Nothing $5 $5 0.72 2.64 2.37 2.35 2.59 2.51 2.25 N

Preferred Plus of Kansas VA $10 Nothing $5 $15

Principal Health Care of KC 7W $10 Nothing $5 $10 0.76 2.69 2.48 2.52 2.66 2.50 2.49 N

Prudential HealthCare HMO 1K $10 Nothing $5 $10 0.65 2.56 2.34 2.36 2.47 2.23 1.95 N

Kentucky 

Advantage Care, Inc. XW $10 Nothing $5 $5 0.72 2.68 2.44 2.59 2.62 2.52 2.46 N

Aetna U.S. Healthcare RD $10 Nothing $5 $10 0.62 2.57 2.45 2.49 2.56 2.28 1.84

Bluegrass Family Health - In-Network 2B $10 Nothing $5 $10

- Out-of-Network 30% Nothing $5 $10

Humana Care Plan 18 $10 Nothing $5 $10 0.70 2.70 2.31 2.44 2.54 2.32 2.97

Humana Care Plan HR $10 Nothing $5 $10 0.74 2.62 2.47 2.52 2.59 2.32 2.25

Humana Health Plan D2 $10 Nothing $5 $10 0.72 2.62 2.39 2.47 2.55 2.32 2.17

PacifiCare of Ohio, Inc. R8 $10 Nothing $10 $10 0.72 2.69 2.48 2.49 2.64 2.39 2.15

Prudential HealthCare HMO Midwest S3 $10 Nothing $5 $15 0.66 2.65 2.40 2.38 2.49 2.24 1.91 N

United Health Care of Ohio 3U $10 Nothing $10 $15 0.76 2.79 2.44 2.42 2.53 2.49 2.22 N

Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State

How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans.

Primary Care Doctor Office shows what you pay for each

office visit to your primary care doctor. A (*) means a POS plan

pays non-plan doctors based on a fee schedule.

Hospital Room Copay/Coinsurance is your share of hospital room and

board charges. This is separate from any per admission deductible. A (*)

means a POS plan pays non-plan hospitals based on a fee schedule.
Primary care doctor

office copayHospital roomcopay/coinsurancePrescription drugs,genericPrescription drugs,brand

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all HMO/POS plans shown in heading)

17

Plan name

Plan

code

Overall plansatisfaction (.74)Getting needed care (2.66)Getting care quickly (2.39)How well doctorscommunicate (2.46)Courteous and helpful office staff (2.55)Customer service (2.44)Claims processing (2.22)Accreditation statusNCQA (N) JCAHO (J)

Louisiana

Aetna U.S. Healthcare NG $10 Nothing $5 $10 X X X X XX X

Aetna U.S. Healthcare TK $10 Nothing $5 $10

Blue Cross and - In-Network 10 $10 Nothing $5 $15 X X X X XX XN

Blue Shield-Std - Out-of-Network 25% 30% 45% 45%

Maxicare Louisiana - In-Network JA $10 Nothing $7 $12 0.75 2.65 2.21 2.41 2.46 2.43 2.76

- Out-of-Network 20% 20% N/A N/A

Maine

Aetna U.S. Healthcare 9M $10 Nothing $5 $10

Harvard Pilgrim Health Care 68 $10 Nothing $5 $15 0.82 2.78 2.45 2.55 2.64 2.47 2.27 N

Maryland

Aetna U.S. Healthcare-High JN $10 Nothing $5 $10 0.76 2.63 2.33 2.41 2.47 2.42 2.23 N

Aetna U.S. Healthcare-Std JN $15 Nothing $10 $15 0.76 2.63 2.33 2.41 2.47 2.42 2.23 N

CapitalCare 2G $10 Nothing $5 $10 0.75 2.59 2.37 2.45 2.58 2.42 2.32 N

Free State Health Plan - In-Network LD $10 Nothing $10 $20 0.74 2.69 2.38 2.53 2.56 2.43 2.25 N

- Out-of-Network 20% 20% $10 $20

George Washington Univ HP E5 $10 Nothing $5 $15 0.69 2.66 2.29 2.39 2.36 2.22 2.64 N

Kaiser Permanente E3 $10 Nothing $7 $7 0.78 2.63 2.35 2.36 2.55 2.50 2.76 N

MD-IPA JP $10 Nothing $5 $10 0.74 2.65 2.42 2.46 2.56 2.53 2.33 N

Prudential HealthCare HMO JB $10 Nothing $5 $15 0.69 2.65 2.38 2.46 2.58 2.23 1.89 N

Prescription Drugs, Generic, Brand shows what you pay for prescriptions when

you use a plan pharmacy. Some plans charge different amounts for refills (*), select

drugs and mail orders. In many plans, if you get the brand name instead of a generic

substitution, you also pay the difference between the two. Where a copay/coinsurance

are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. 

Satisfaction Indicators — See page 7 for a description

of these results. An (X) means the plan did not conduct

the survey as we asked.

Accreditation status — N = National Committee for

Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations
Primary care doctor

office copayHospital roomcopay/coinsurancePrescription drugs,genericPrescription drugs,brand

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all HMO/POS plans shown in heading)

18

Plan name

Plan

code

Overall plansatisfaction (.74)Getting needed care (2.66)Getting care quickly (2.39)How well doctorscommunicate (2.46)Courteous and helpful office staff (2.55)Customer service (2.44)Claims processing (2.22)Accreditation statusNCQA (N) JCAHO (J)

Massachusetts

Aetna U.S. Healthcare NE $10 Nothing $5 $10 0.63 2.66 2.55 2.55 2.63 2.19 1.86 N

Blue Chip, Coord - In-Network DA $10 Nothing $5 $15 0.74 2.75 2.48 2.58 2.64 2.45 2.25 N

Hlth Partners - Out-of-Network 20% 20% $5 $15

Blue Cross and - In-Network 10 $10 Nothing $5 $15 0.85 2.77 2.51 2.52 2.63 2.53 2.33 N

Blue Shield-Std- Out-of-Network 25% 30% 45% 45%

Fallon Community Health Plan JV $10 Nothing $5 $10 0.89 2.78 2.53 2.61 2.72 2.63 2.53 N

Harvard Pilgrim Health Care 68 $10 Nothing $5 $15 0.82 2.78 2.45 2.55 2.64 2.47 2.27 N

Harvard Pilgrim Hlth Care-NE 70 $10 Nothing $5 $15 0.84 2.79 2.46 2.52 2.59 2.46 2.26 N

Health New England DJ $10 Nothing $7 $15 0.90 2.79 2.41 2.49 2.54 2.78 2.57 N

Michigan

Aetna U.S. Healthcare 8Z $10 Nothing $5 $10

Blue Care Network West MI G7 $10 Nothing $5 $5 N

Blue Care Network West MI K5 $10 Nothing $5 $5 N

Blue Care Network West MI KF $10 Nothing $5 $5 N

Blue Care Network West MI KN $10 Nothing $5 $5 N

Blue Care Network West MI KR $10 Nothing $5 $5 N

Blue Care Network West MI LN $10 Nothing $5 $5 N

Blue Care Network West MI LX $10 Nothing $5 $5 N

Grand Valley Health Plan RL $10 Nothing $5 $5 N

Health Alliance 52 $10 Nothing $2 $2 0.82 2.70 2.35 2.42 2.49 2.52 2.40 N

HealthPlus MI X5 $10 Nothing $5 $5 N

M-Care EG $10 Nothing $5 $10 0.82 2.76 2.41 2.55 2.57 2.59 2.36 N

OmniCare KA $10 Nothing $2 $2 N

Physicians Health Plan U8 $10 Nothing $5 $5 0.81 2.77 2.53 2.52 2.63 2.55 2.43

Priority Health BQ $10 Nothing $5 $5 0.85 2.79 2.50 2.55 2.62 2.59 2.53 N

SelectCare HMO K6 $10 Nothing $2 $2 0.73 2.61 2.41 2.49 2.59 2.41 2.23 N

The Wellness Plan K3 $10 Nothing $5 $5 0.60 2.51 2.25 2.31 2.38 2.15 1.88

Total Health Care N2 $10 Nothing Nothing Nothing

Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State

How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans.

Primary Care Doctor Office shows what you pay for each

office visit to your primary care doctor. A (*) means a POS plan

pays non-plan doctors based on a fee schedule.

Hospital Room Copay/Coinsurance is your share of hospital room and

board charges. This is separate from any per admission deductible. A (*)

means a POS plan pays non-plan hospitals based on a fee schedule.
Primary care doctor

office copayHospital roomcopay/coinsurancePrescription drugs,genericPrescription drugs,brand

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all HMO/POS plans shown in heading)

19

Plan name

Plan

code

Overall plansatisfaction (.74)Getting needed care (2.66)Getting care quickly (2.39)How well doctorscommunicate (2.46)Courteous and helpful office staff (2.55)Customer service (2.44)Claims processing (2.22)Accreditation statusNCQA (N) JCAHO (J)

Minnesota

APWU Health Plan - In-Network 47 $10 Nothing 20%* 20%*

- Out-of-Network 30% 30% 40% 40%

Blue Cross and - In-Network 10 $10 Nothing $5 $15 0.76 2.69 2.37 2.42 2.52 2.35 2.40

Blue Shield-Std- Out-of-Network 25% 30% 45% 45%

HealthPartners Classic-High 53 $10 Nothing $8 $8 0.77 2.76 2.39 2.48 2.56 2.47 2.30 N

HealthPartners Classic-Std 53 $15 Nothing $10 $10 0.77 2.76 2.39 2.48 2.56 2.47 2.30 N

HealthPartners Health Plan HQ $10 Nothing $8 $8 0.77 2.76 2.39 2.48 2.56 2.47 2.30 N

Mississippi

Prudential HealthCare HMO UB $10 Nothing $5 $15 0.64 2.64 2.82 2.37 2.38 2.25 1.89 N

Missouri

Aetna U.S. Healthcare 7M $10 Nothing $5 $10

BlueCHOICE 9G $10 Nothing $5 $10 0.68 2.67 2.43 2.51 2.59 2.37 2.15 N

Group Health Plan MM $10 Nothing $7 $12 0.72 2.62 2.38 2.44 2.53 2.28 2.89 N

Health Partners of the Midwest RN $10 Nothing $7 $12 X X X X XX X

Humana Kansas City, Inc.-High MS $10 Nothing $5 $10 X X X X XX XN

Humana Kansas City, Inc.-Std MS $15 Nothing $10 $20 X X X X XX XN

Kaiser Permanente HA $10 Nothing $5 $5 0.72 2.64 2.37 2.35 2.59 2.51 2.25 N

Mercy Health - In-Network 7M $10 Nothing $7 $12

Plans/Premier - Out-of-Network 30% 30% $7 $12

Prudential HealthCare HMO 1K $10 Nothing $5 $10 0.65 2.56 2.34 2.36 2.47 2.23 1.95 N

Prudential HealthCare HMO VZ $10 Nothing $5 $15 0.68 2.68 2.47 2.46 2.60 2.27 2.38 N

Prescription Drugs, Generic, Brand shows what you pay for prescriptions when

you use a plan pharmacy. Some plans charge different amounts for refills (*), select

drugs and mail orders. In many plans, if you get the brand name instead of a generic

substitution, you also pay the difference between the two. Where a copay/coinsurance

are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. 

Satisfaction Indicators — See page 7 for a description

of these results. An (X) means the plan did not conduct

the survey as we asked.

Accreditation status — N = National Committee for

Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations
Primary care doctor

office copayHospital roomcopay/coinsurancePrescription drugs,genericPrescription drugs,brand

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all HMO/POS plans shown in heading)

20

Plan name

Plan

code

Overall plansatisfaction (.74)Getting needed care (2.66)Getting care quickly (2.39)How well doctorscommunicate (2.46)Courteous and helpful office staff (2.55)Customer service (2.44)Claims processing (2.22)Accreditation statusNCQA (N) JCAHO (J)

Nebraska

Care Choices FA $10 Nothing $5 $5 X X X X XX X

GEHA Benefit Plan - In-Network 31 $10 Nothing $5* $15*

- Out-of-Network 25% Nothing $5* $15*

Nevada

Aetna U.S. Healthcare 8L $10 Nothing $5 $10

Health Plan of Nevada - In-Network NM $10 Nothing $6 $12 0.64 2.39 2.17 2.25 2.35 2.24 2.13 N

- Out-of-Network 20% 20% $6 $12

HMO Colorado - In-Network VS $10 Nothing $5 $15 N

/Nevada - Out-of-Network 30% 30% N/A N/A

Humana Health Plan, Inc. TL $10 Nothing $5 $10

PacifiCare of Nevada K9 $10 Nothing $5 $5 0.54 2.42 2.23 2.25 2.35 2.25 2.20 N

New Hampshire

Harvard Pilgrim Health Care 68 $10 Nothing $5 $15 0.82 2.78 2.45 2.55 2.64 2.47 2.27 N

New Jersey

Aetna U.S. Healthcare-High P3 $10 Nothing $5 $10 0.79 2.79 2.48 2.51 2.59 2.46 2.25 N

Aetna U.S. Healthcare-Std P3 $15 Nothing $10 $15 0.79 2.79 2.48 2.51 2.59 2.46 2.25 N

AmeriHealth HMO FK $10 Nothing $5 $5 0.78 2.74 2.60 2.60 2.62 2.44 2.21 N

Blue Cross and - In-Network 10 $10 Nothing $5 $15 0.67 2.63 2.35 2.41 2.58 2.34 1.91 N

Blue Shield-Std- Out-of-Network 25% 30% 45% 45%

CIGNA CoMED HealthCare P4 $10 Nothing $10 $20 0.62 2.57 2.26 2.32 2.35 2.23 1.84 N

Physicians Health Services of NJ 2F $10 Nothing $10 $20 0.76 2.73 2.42 2.50 2.53 2.25 2.12

GHI Health Plan - In-Network 80 $10 Nothing $5 $15 0.75 2.80 2.42 2.50 2.62 2.29 2.23

- Out-of-Network 50%* 50%* $5 $15

Prudential HealthCare HMO 8P $10 Nothing $5 $15 0.52 2.65 2.36 2.38 2.38 2.17 1.72 N

QualMed Plans for Health 27 $10 Nothing $4 $4 0.66 2.53 2.49 2.48 2.56 2.32 2.16 N

Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State

How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans.

Primary Care Doctor Office shows what you pay for each

office visit to your primary care doctor. A (*) means a POS plan

pays non-plan doctors based on a fee schedule.

Hospital Room Copay/Coinsurance is your share of hospital room and

board charges. This is separate from any per admission deductible. A (*)

means a POS plan pays non-plan hospitals based on a fee schedule.
Primary care doctor

office copayHospital roomcopay/coinsurancePrescription drugs,genericPrescription drugs,brand

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all HMO/POS plans shown in heading)

21

Plan name

Plan

code

Overall plansatisfaction (.74)Getting needed care (2.66)Getting care quickly (2.39)How well doctorscommunicate (2.46)Courteous and helpful office staff (2.55)Customer service (2.44)Claims processing (2.22)Accreditation statusNCQA (N) JCAHO (J)

Prescription Drugs, Generic, Brand shows what you pay for prescriptions when

you use a plan pharmacy. Some plans charge different amounts for refills (*), select

drugs and mail orders. In many plans, if you get the brand name instead of a generic

substitution, you also pay the difference between the two. Where a copay/coinsurance

are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. 

Satisfaction Indicators — See page 7 for a description

of these results. An (X) means the plan did not conduct

the survey as we asked.

Accreditation status — N = National Committee for

Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations

New Mexico

Lovelace Health Plan Q1 $10 Nothing $5 $10 0.73 2.65 2.33 2.45 2.47 2.28 2.12 J,N

Presbyterian Health Plan P2 $10 Nothing $5 $15

QualMed Plans for Health PX $10 Nothing $5 $8 0.78 2.63 2.35 2.49 2.46 2.44 2.37

New York

Aetna U.S. Healthcare JC $10 Nothing $5 $10 0.78 2.69 2.33 2.44 2.45 2.52 2.19 N

Blue Choice MK $10 Nothing $8 $8 0.87 2.80 2.55 2.52 2.64 2.67 2.64 N

Blue Cross and - In-Network 10 $10 Nothing $5 $15 0.72 2.69 2.45 2.50 2.53 2.34 2.11 N

Blue Shield-Std- Out-of-Network 25% 30% 45% 45%

BlueChoice HMO 5L $10 Nothing $5 $5 X X X X XX XN

BlueChoice HMO S7 $10 Nothing $5 $5 X X X X XX XN

C.D.P.H.P. SG $10 Nothing $5 $10 0.88 2.87 2.53 2.54 2.59 2.66 2.58 N

CIGNA HealthCare of NY HU $10 Nothing $7 $14 0.58 2.47 2.23 2.27 2.28 2.29 1.88

GHI Health Plan - In-Network 80 $10 Nothing $5 $15 0.75 2.80 2.42 2.50 2.62 2.29 2.23

- Out-of-Network 50%* 50%* $5 $15

GHI HMO Select 6V $10 Nothing $10 $10 X X X X XX XN

GHI HMO Select X4 $10 Nothing $10 $10 X X X X XX XN

Harvard Pilgrim Health Care 68 $10 Nothing $5 $15 0.82 2.78 2.45 2.55 2.64 2.47 2.27 N

HealthCarePlan Q8 $10 Nothing $5 $5 0.82 2.78 2.56 2.52 2.67 2.53 2.36 N

HIP of Greater New York 51 $10 Nothing $10 $10 0.71 2.67 2.10 2.31 2.32 2.42 2.12 N

HMO Blue AH $10 Nothing $5 $20 0.73 2.78 2.52 2.57 2.69 2.49 2.22

HMO-CNY EB $10 Nothing $5 $20 0.77 2.76 2.49 2.49 2.61 2.47 2.29 N
Primary care doctor

office copayHospital roomcopay/coinsurancePrescription drugs,genericPrescription drugs,brand

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all HMO/POS plans shown in heading)

22

Plan name

Plan

code

Overall plansatisfaction (.74)Getting needed care (2.66)Getting care quickly (2.39)How well doctorscommunicate (2.46)Courteous and helpful office staff (2.55)Customer service (2.44)Claims processing (2.22)Accreditation statusNCQA (N) JCAHO (J)

New York (continued)

Independent Health Assoc C1 $10 Nothing $5 $10 0.77 2.69 2.43 2.56 2.68 2.46 2.19 N

Independent Health Assoc QA $10 Nothing $5 $10 0.83 2.79 2.44 2.57 2.67 2.65 2.51 N

Kaiser Permanente PW $10 Nothing 20% 20% 0.75 2.73 2.49 2.54 2.61 2.39 2.33 N

Kaiser Permanente QB $10 Nothing 20% 20% 0.75 2.73 2.49 2.54 2.61 2.39 2.33 N

Kaiser Permanente QH $10 Nothing $5 $10 0.75 2.73 2.49 2.54 2.61 2.39 2.33

MDNY Healthcare, Inc. 5Y $10 Nothing $5 $15 X X X X XX X

MDNY Healthcare, Inc. 8U $10 Nothing $5 $15

MVP Health Plan GA $10 Nothing $5 $10 0.85 2.79 2.57 2.57 2.65 2.55 2.44 N

MVP Health Plan M9 $10 Nothing $5 $10 0.85 2.79 2.57 2.57 2.65 2.55 2.44 N

MVP Health Plan MX $10 Nothing $5 $10 0.85 2.79 2.57 2.57 2.65 2.55 2.44 N

Partners Health Plans 7Y $10 Nothing $5 $10

PHP/Mohawk Valley Region SH $10 Nothing $5 $10 0.81 2.76 2.53 2.54 2.70 2.52 2.38

Physicians Health Srvs of NY PD $10 Nothing $10 $20 0.76 2.73 2.42 2.50 2.53 2.25 2.12 N

Preferred Care GV $10 Nothing $5 $10 0.84 2.79 2.52 2.53 2.60 2.57 2.52 N

Prepaid Health Plan QE $10 Nothing $5 $10 0.81 2.76 2.53 2.54 2.70 2.52 2.38

Prudential HealthCare HMO 9P $10 Nothing $5 $15 0.52 2.65 2.36 2.38 2.38 2.17 1.72 N

Vytra Health Plans J6 $10 Nothing $5 $5 0.84 2.75 2.38 2.49 2.53 2.46 2.18

North Carolina

Aetna U.S. Healthcare 3G $10 Nothing $5 $10 0.58 2.56 2.44 2.52 2.62 2.12 1.77

Doctors Health Plan, Inc. 6D $10 Nothing $5 $10 0.77 2.67 2.41 2.47 2.57 2.41 2.54

Generations Family Health Plan 8B $10 Nothing $5 $15 0.79 2.60 2.36 2.42 2.47 2.55 2.36

PARTNERS NHP of NC EQ $10 Nothing $10 $10 0.82 2.74 2.46 2.44 2.54 2.54 2.41 N

Prudential HealthCare HMO Q4 $10 Nothing $5 $15 0.56 2.52 2.33 2.37 2.42 2.24 1.94 N

QualChoice of - In-Network 7Q $10 Nothing $6 $12

North Carolina- Out-of-Network $10 Nothing $6 $12

UHC of North Carolina XM $10 Nothing $10 $15 0.82 2.83 2.48 2.52 2.62 2.59 2.45 N

Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State

How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans.

Primary Care Doctor Office shows what you pay for each

office visit to your primary care doctor. A (*) means a POS plan

pays non-plan doctors based on a fee schedule.

Hospital Room Copay/Coinsurance is your share of hospital room and

board charges. This is separate from any per admission deductible. A (*)

means a POS plan pays non-plan hospitals based on a fee schedule.
Primary care doctor

office copayHospital roomcopay/coinsurancePrescription drugs,genericPrescription drugs,brand

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all HMO/POS plans shown in heading)

23

Plan name

Plan

code

Overall plansatisfaction (.74)Getting needed care (2.66)Getting care quickly (2.39)How well doctorscommunicate (2.46)Courteous and helpful office staff (2.55)Customer service (2.44)Claims processing (2.22)Accreditation statusNCQA (N) JCAHO (J)

North Dakota

Blue Cross and - In-Network 10 $10 Nothing $5 $15 0.87 2.81 2.50 2.51 2.67 2.52 2.52

Blue Shield-Std- Out-of-Network 25% 30% 45% 45%

Heart of America HMO RU $10 Nothing 50% 50%

Ohio

Aetna U.S. Healthcare RD $10 Nothing $5 $10 0.62 2.57 2.45 2.49 2.56 2.28 1.84 N

AultCare HMO 3A $10 Nothing $5 $10 0.82 2.64 2.51 2.55 2.63 2.54 2.47

Blue Cross and - In-Network 10 $10 Nothing $5 $15 0.72 2.72 2.46 2.45 2.53 2.37 2.15 N

Blue Shield-Std- Out-of-Network 25% 30% 45% 45%

CHP of Ohio MG $10 Nothing $5 $5 0.78 2.66 2.48 2.55 2.64 2.62 2.44

Health Maintenance Plan(HMP) R5 $10 Nothing $5 $12 0.71 2.72 2.46 2.45 2.53 2.37 2.15 N

Health Plan Upper OH Valley U4 $10 Nothing $5 $10 N

HMO Health Ohio L4 $10 Nothing $5 $5 0.72 2.64 2.37 2.45 2.54 2.32 2.20 N

Kaiser Permanente 64 $10 Nothing $5 $5 0.78 2.70 2.35 2.39 2.58 2.58 2.29 N

PacifiCare of Ohio, Inc. R8 $10 Nothing $10 $10 0.72 2.69 2.48 2.49 2.64 2.39 2.15

Paramount Health Care U2 $10 Nothing $5 $10 0.86 2.82 2.48 2.56 2.58 2.65 2.54 N

Prudential HealthCare HMO Midwest Q9 $10 Nothing $5 $15 0.66 2.65 2.40 2.38 2.49 2.24 1.91 N

Prudential HealthCare HMO Midwest S3 $10 Nothing $5 $15 0.66 2.65 2.40 2.38 2.49 2.24 1.91 N

QualMed Plans for Health OH/WV QJ $10 Nothing $10 $10 0.69 2.55 2.57 2.56 2.69 2.28 2.30

SummaCare Health Plan 5W $10 Nothing $5 $10

Super Med HMO 5M $10 Nothing $5 $5 N

United Health Care of Ohio 3U $10 Nothing $10 $15 0.76 2.79 2.44 2.42 2.53 2.49 2.22 N

United Health Care of Ohio VC $10 Nothing $10 $15 0.73 2.74 2.46 2.48 2.58 2.42 2.18 N

Vantage Health Plan 6A $10 Nothing $10 $10

Prescription Drugs, Generic, Brand shows what you pay for prescriptions when

you use a plan pharmacy. Some plans charge different amounts for refills (*), select

drugs and mail orders. In many plans, if you get the brand name instead of a generic

substitution, you also pay the difference between the two. Where a copay/coinsurance

are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. 

Satisfaction Indicators — See page 7 for a description

of these results. An (X) means the plan did not conduct

the survey as we asked.

Accreditation status — N = National Committee for

Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations
Primary care doctor

office copayHospital roomcopay/coinsurancePrescription drugs,genericPrescription drugs,brand

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all HMO/POS plans shown in heading)

24

Plan name

Plan

code

Overall plansatisfaction (.74)Getting needed care (2.66)Getting care quickly (2.39)How well doctorscommunicate (2.46)Courteous and helpful office staff (2.55)Customer service (2.44)Claims processing (2.22)Accreditation statusNCQA (N) JCAHO (J)

Oklahoma

Aetna U.S. Healthcare 8V $10 Nothing $5 $10

Blue Cross and - In-Network 10 $10 Nothing $5 $15 0.69 2.57 2.43 2.46 2.52 2.22 2.86

Blue Shield-Std- Out-of-Network 25% 30% 45% 45%

BlueLincs HMO N5 $10 Nothing $5 $10 0.67 2.55 2.35 2.39 2.55 2.33 2.71 N

CommunityCare HMO 7C $10 Nothing $5 $5 J

Healthcare Oklahoma 6W $10 Nothing $5 $10 0.75 2.70 2.43 2.53 2.58 2.43 2.27

PacifiCare OK 2N $10 Nothing $5 $10 0.71 2.56 2.28 2.39 2.52 2.45 2.35 N

Prudential HealthCare HMO RR $10 Nothing $5 $15 0.76 2.63 2.36 2.42 2.55 2.38 1.98 N

Prudential HealthCare HMO RS $10 Nothing $5 $15 0.76 2.63 2.36 2.42 2.55 2.38 1.98 N

Oregon

Kaiser Permanente-High 57 $10 Nothing $10 $10 0.76 2.69 2.34 2.39 2.51 2.62 2.58 N

Kaiser Permanente-Std 57 $12 Nothing $15 $15 0.76 2.69 2.34 2.39 2.51 2.62 2.58 N

PacifiCare of Oregon 7Z $10 Nothing $10 $15

Pennsylvania

Aetna U.S. Healthcare-High KL $10 Nothing $5 $10 0.74 2.72 2.46 2.51 2.58 2.38 2.10 N

Aetna U.S. Healthcare-Std KL $15 Nothing $10 $15 0.74 2.72 2.46 2.51 2.58 2.38 2.10 N

Aetna U.S. Healthcare-High SU $10 Nothing $5 $10 0.77 2.76 2.53 2.50 2.56 2.45 2.40 N

Aetna U.S. Healthcare-Std SU $15 Nothing $10 $15 0.77 2.76 2.53 2.50 2.56 2.45 2.40 N

First Priority Hlth C8 $10 Nothing $8 $8 0.78 2.77 2.59 2.70 2.67 2.50 2.47 N

Free State - In-Network LD $10 Nothing $10 $20 0.74 2.69 2.38 2.53 2.56 2.43 2.25 N

Health Plan - Out-of-Network 20% 20% $10 $20

HealthAmerica Pennsylvania 26 $10 Nothing $5 $10 0.76 2.73 2.49 2.49 2.59 2.40 2.34 N

Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State

How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans.

Primary Care Doctor Office shows what you pay for each

office visit to your primary care doctor. A (*) means a POS plan

pays non-plan doctors based on a fee schedule.

Hospital Room Copay/Coinsurance is your share of hospital room and

board charges. This is separate from any per admission deductible. A (*)

means a POS plan pays non-plan hospitals based on a fee schedule.
Primary care doctor

office copayHospital roomcopay/coinsurancePrescription drugs,genericPrescription drugs,brand

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all HMO/POS plans shown in heading)

25

Plan name

Plan

code

Overall plansatisfaction (.74)Getting needed care (2.66)Getting care quickly (2.39)How well doctorscommunicate (2.46)Courteous and helpful office staff (2.55)Customer service (2.44)Claims processing (2.22)Accreditation statusNCQA (N) JCAHO (J)

Pennsylvania (continued)

HealthAmerica Pennsylvania SW $10 Nothing $5 $10 0.76 2.73 2.49 2.49 2.59 2.40 2.34

HealthGuard NQ $10 Nothing $5 $15 0.85 2.75 2.53 2.49 2.59 2.66 2.52 N

Keystone Health Plan Central S4 $10 Nothing $10 $10 0.84 2.73 2.49 2.47 2.54 2.55 2.47 N

Keystone Health Plan East ED $10 Nothing $5 $5 0.77 2.81 2.46 2.58 2.60 2.52 2.37 N

KeystoneBlue EF $10 Nothing $8 $14 0.72 2.74 2.43 2.46 2.54 2.47 2.48 N

Penn State Geisinger - In-Network N9 $10 Nothing $8 $8 0.85 2.79 2.54 2.55 2.65 2.55 2.48 N

HlthPlan - Out-of-Network 20% 20% N/A N/A

Prudential HealthCare HMO VV $10 Nothing $5 $15 0.52 2.65 2.36 2.38 2.38 2.17 1.72 N

QualMed Plans for Health -Pa. 24 $10 Nothing $5 $8 0.59 2.69 2.48 2.55 2.59 2.21 1.87

QualMed Plans for Health 27 $10 Nothing $4 $4 0.66 2.53 2.49 2.48 2.56 2.32 2.16 N

QualMed Plans for Health 2K $10 Nothing $4 $4 N

UPMC Health Plan 8W $10 Nothing $5 $15

Puerto Rico

Triple-S - In-Network 89 $7.50 Nothing Nothing $10 0.90 2.93 2.27 2.56 2.55 2.64 2.19

- Out-of-Network $7.50 All over Nothing $10 $60/day

United HealthCare - In-Network 7U $7.50 Nothing Nothing $5

Puerto Rico - Out-of-Network 20% 20% 20% 20%

Rhode Island

Aetna U.S. Healthcare 5U $10 Nothing $5 $10

Blue Chip, Coord - In-Network DA $10 Nothing $5 $15 0.74 2.75 2.48 2.58 2.64 2.45 2.25 N

Hlth Partners - Out-of-Network 20% 20% $5 $15

Harvard Pilgrim Hlth Care-NE 70 $10 Nothing $5 $15 0.84 2.79 2.46 2.52 2.59 2.46 2.26 N

Prescription Drugs, Generic, Brand shows what you pay for prescriptions when

you use a plan pharmacy. Some plans charge different amounts for refills (*), select

drugs and mail orders. In many plans, if you get the brand name instead of a generic

substitution, you also pay the difference between the two. Where a copay/coinsurance

are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. 

Satisfaction Indicators — See page 7 for a description

of these results. An (X) means the plan did not conduct

the survey as we asked.

Accreditation status — N = National Committee for

Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations
Primary care doctor

office copayHospital roomcopay/coinsurancePrescription drugs,genericPrescription drugs,brand

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all HMO/POS plans shown in heading)

26

Plan name

Plan

code

Overall plansatisfaction (.74)Getting needed care (2.66)Getting care quickly (2.39)How well doctorscommunicate (2.46)Courteous and helpful office staff (2.55)Customer service (2.44)Claims processing (2.22)Accreditation statusNCQA (N) JCAHO (J)

South Carolina

Doctors Health Plan, Inc. 6D $10 Nothing $5 $10 0.77 2.67 2.41 2.47 2.57 2.41 2.54

PARTNERS NHP of NC EQ $10 Nothing $10 $10 0.82 2.74 2.46 2.44 2.54 2.54 2.41 N

Prudential HealthCare HMO Q4 $10 Nothing $5 $15 0.56 2.52 2.33 2.37 2.42 2.24 1.94 N

South Dakota

Care Choices FA $10 Nothing $5 $5 X X X X XX X

Tennessee

Aetna U.S. Healthcare 6J $10 Nothing $5 $10 0.61 2.64 2.36 2.60 2.54 2.28 1.89

American Healthcare Trust, Inc 4U $10 Nothing $10 $10

John Deere Health Plan 3J $10 Nothing $5 $15

Prudential HealthCare HMO UA $10 Nothing $5 $15 0.76 2.70 2.40 2.49 2.58 2.40 2.91 N

Prudential HealthCare HMO UB $10 Nothing $5 $15 0.64 2.64 2.82 2.37 2.38 2.25 1.89 N

Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State

How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans.

Primary Care Doctor Office shows what you pay for each

office visit to your primary care doctor. A (*) means a POS plan

pays non-plan doctors based on a fee schedule.

Hospital Room Copay/Coinsurance is your share of hospital room and

board charges. This is separate from any per admission deductible. A (*)

means a POS plan pays non-plan hospitals based on a fee schedule.
Primary care doctor

office copayHospital roomcopay/coinsurancePrescription drugs,genericPrescription drugs,brand

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all HMO/POS plans shown in heading)

27

Plan name

Plan

code

Overall plansatisfaction (.74)Getting needed care (2.66)Getting care quickly (2.39)How well doctorscommunicate (2.46)Courteous and helpful office staff (2.55)Customer service (2.44)Claims processing (2.22)Accreditation statusNCQA (N) JCAHO (J)

Texas

Aetna U.S. Healthcare 5B $10 Nothing $5 $10

Aetna U.S. Healthcare 8X $10 Nothing $5 $10

Aetna U.S. Healthcare TS $10 Nothing $5 $10 0.64 2.59 2.32 2.44 2.54 2.32 2.88 N

APWU Health Plan - In-Network 47 $10 Nothing 20%* 20%*

- Out-of-Network 30% 30% 40% 40%

FIRSTCARE 6U $10 Nothing $5 $15 0.82 2.72 2.46 2.53 2.62 2.61 2.53

FIRSTCARE CK $10 Nothing $5 $15 0.82 2.72 2.46 2.53 2.62 2.61 2.53

Humana Health Plan of Texas TW $10 Nothing $5 $10 0.64 2.57 2.38 2.46 2.55 2.19 2.25 N

Humana Health Plan of Texas TX $10 Nothing $5 $10 0.79 2.57 2.34 2.46 2.59 2.43 2.30

Humana Health Plan of Texas UE $10 Nothing $5 $10 0.59 2.43 2.24 2.39 2.43 2.23 1.94 N

Humana Health Plan of Texas UR $10 Nothing $5 $10 0.72 2.44 2.22 2.36 2.45 2.38 2.16 N

NYLCare Health Plans SW V2 $10 Nothing $5 $10 0.70 2.53 2.28 2.36 2.47 2.43 2.22 N

NYLCare HP of the Gulf Coast UM $10 Nothing $5 $10 X X X X XX XN

NYLCare HP of the Gulf Coast ZE $10 Nothing $5 $10 N

NYLCare HP of the Gulf Coast ZF $10 Nothing $5 $10 N

PacifiCare of Texas GF $10 Nothing $5 $10 X X X X XX X

Prudential HealthCare HMO UP $10 Nothing $5 $10 0.68 2.60 2.10 2.25 2.37 2.32 1.97 N

Prudential HealthCare HMO VX $10 Nothing $5 $10 0.75 2.65 2.28 2.44 2.50 2.44 2.24 N

Scott and White UF $10 Nothing $10 $15 0.88 2.82 2.48 2.56 2.68 2.54 2.60 N

Texas Health Choice, L. C. 2T $10 Nothing $6 $12

Texas Health Choice, L. C. UK $10 Nothing $6 $12 0.76 2.56 2.36 2.32 2.50 2.28 2.24 N

Utah

Altius Health Plans 9K $10 Nothing $10 $15 0.69 2.55 2.36 2.42 2.53 2.17 2.36 N

Vermont

Harvard Pilgrim Health Care 68 $10 Nothing $5 $15 0.82 2.78 2.45 2.55 2.64 2.47 2.27 N

MVP Health Plan VW $10 Nothing $5 $10 N

Prescription Drugs, Generic, Brand shows what you pay for prescriptions when

you use a plan pharmacy. Some plans charge different amounts for refills (*), select

drugs and mail orders. In many plans, if you get the brand name instead of a generic

substitution, you also pay the difference between the two. Where a copay/coinsurance

are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. 

Satisfaction Indicators — See page 7 for a description

of these results. An (X) means the plan did not conduct

the survey as we asked.

Accreditation status — N = National Committee for

Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations
Primary care doctor

office copayHospital roomcopay/coinsurancePrescription drugs,genericPrescription drugs,brand

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all HMO/POS plans shown in heading)

28

Plan name

Plan

code

Overall plansatisfaction (.74)Getting needed care (2.66)Getting care quickly (2.39)How well doctorscommunicate (2.46)Courteous and helpful office staff (2.55)Customer service (2.44)Claims processing (2.22)Accreditation statusNCQA (N) JCAHO (J)

Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State

How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans.

Primary Care Doctor Office shows what you pay for each

office visit to your primary care doctor. A (*) means a POS plan

pays non-plan doctors based on a fee schedule.

Hospital Room Copay/Coinsurance is your share of hospital room and

board charges. This is separate from any per admission deductible. A (*)

means a POS plan pays non-plan hospitals based on a fee schedule.

Virginia

Aetna U.S. Healthcare-High JN $10 Nothing $5 $10 0.76 2.63 2.33 2.41 2.47 2.42 2.23 N

Aetna U.S. Healthcare-Std JN $15 Nothing $10 $15 0.76 2.63 2.33 2.41 2.47 2.42 2.23 N

Aetna U.S. Healthcare Z1 $10 Nothing $5 $10 0.63 2.62 2.40 2.47 2.52 2.18 1.96 N

CapitalCare 2G $10 Nothing $5 $10 0.75 2.59 2.37 2.45 2.58 2.42 2.32 N

CIGNA HealthCare of VA W2 $10 Nothing $5 $10 0.72 2.64 2.37 2.40 2.49 2.45 2.21 N

CIGNA HealthCare of VA W3 $10 Nothing $5 $10 0.72 2.64 2.37 2.40 2.49 2.45 2.21 N

George Washington Univ HP E5 $10 Nothing $5 $15 0.69 2.66 2.29 2.39 2.36 2.22 2.64 N

Healthkeepers X8 $10 Nothing $5 $10 0.75 2.77 2.40 2.47 2.57 2.45 2.33 N

John Deere Health Plan 3J $10 Nothing $5 $15

Kaiser Permanente E3 $10 Nothing $7 $7 0.78 2.63 2.35 2.36 2.55 2.50 2.76 N

MD-IPA JP $10 Nothing $5 $10 0.74 2.65 2.42 2.46 2.56 2.53 2.33 N

OPTIMA Health Plan 9R $10 Nothing $8 $8 0.84 2.75 2.40 2.53 2.59 2.63 2.46 N

PARTNERS NHP of NC EQ $10 Nothing $10 $10 0.82 2.74 2.46 2.44 2.54 2.54 2.41 N

Piedmont Community - In-Network 2C $10 10% $5 $15

Healthcare - Out-of-Network 30% 30% $5 $15

Prudential HealthCare HMO JB $10 Nothing $5 $15 0.69 2.65 2.38 2.46 2.58 2.23 1.89 N

Prudential HealthCare HMO V6 $10 Nothing $5 $15 0.69 2.65 2.38 2.46 2.58 2.23 1.89 N

Washington

Aetna U.S. Healthcare 8J $10 Nothing $5 $10

First Choice Health Plan 5G $10 Nothing $5 $10 0.64 2.56 2.37 2.51 2.57 2.25 1.98

Group Health Cooperative 54 $10 Nothing $7 $7 0.78 2.74 2.47 2.54 2.68 2.42 2.34 N

Group Health Cooperative VR $10 Nothing $7 $7 0.79 2.74 2.49 2.57 2.66 2.55 2.47 N

Kaiser Permanente-High 57 $10 Nothing $10 $10 0.76 2.69 2.34 2.39 2.51 2.62 2.58 N

Kaiser Permanente-Std 57 $12 Nothing $15 $15 0.76 2.69 2.34 2.39 2.51 2.62 2.58 N

Kitsap Physicians Service-High VT $10 Nothing 50% 50% 0.86 2.87 2.58 2.52 2.74 2.54 2.54

Kitsap Physicians Service-Std VT 20% 20% 20% 20% 0.86 2.87 2.58 2.52 2.74 2.54 2.54

PacifiCare of Oregon 7Z $10 Nothing $10 $15 N

PacifiCare of Washington WB $10 Nothing $5 $10 0.69 2.60 2.34 2.45 2.56 2.45 2.38

Premera HealthPlus 8F $10 Nothing $5 $10 X X X X XX X

QualMed WA Health Plan TM $10 Nothing $10 $20 0.73 2.60 2.56 2.56 2.66 2.42 2.25 N
Primary care doctor

office copayHospital roomcopay/coinsurancePrescription drugs,genericPrescription drugs,brand

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all HMO/POS plans shown in heading)

29

Plan name

Plan

code

Overall plansatisfaction (.74)Getting needed care (2.66)Getting care quickly (2.39)How well doctorscommunicate (2.46)Courteous and helpful office staff (2.55)Customer service (2.44)Claims processing (2.22)Accreditation statusNCQA (N) JCAHO (J)

West Virginia

Carelink Health Plans 4C $10 Nothing $10 $20

Free State - In-Network LD $10 Nothing $10 $20 0.74 2.69 2.38 2.53 2.56 2.43 2.25 N

Health Plan - Out-of-Network 20% 20% $10 $20

Health Plan Upper OH Valley U4 $10 Nothing $5 $10 N

HealthAssurance HMO 6L $10 Nothing $10 $10 0.74 2.68 2.51 2.56 2.70 2.24 2.89

QualMed Plans for Hlth OH/WV QJ $10 Nothing $10 $10 0.69 2.55 2.57 2.56 2.69 2.28 2.30

SuperBlue HMO 8T $10 Nothing $10 $20

Wisconsin

Compcare Health Services 69 $10 Nothing $7 $12 0.62 2.70 2.47 2.47 2.58 2.17 1.92 N

Compcare Health Services 6X $10 Nothing $7 $12 N

Dean Health Plan WD $10 Nothing $6 $10 0.88 2.86 2.53 2.53 2.68 2.58 2.51 N

Family Health Plan WH $10 Nothing Nothing Nothing 0.70 2.72 2.38 2.39 2.44 2.44 1.98

Group Health Coop WJ $10 Nothing Nothing Nothing 0.85 2.74 2.49 2.49 2.58 2.65 2.67 N

Group Hlth Coop/Eau Claire WT $10 Nothing $7.50 $7.50 0.86 2.79 2.57 2.55 2.64 2.63 2.52

HealthPartners Classic-High 53 $10 Nothing $8 $8 0.77 2.76 2.39 2.48 2.56 2.47 2.30 N

HealthPartners Classic-Std 53 $15 Nothing $10 $10 0.77 2.76 2.39 2.48 2.56 2.47 2.30 N

HealthPartners Health Plan HQ $10 Nothing $8 $8 0.77 2.76 2.39 2.48 2.56 2.47 2.30 N

Humana Wisconsin Hlth Org. X1 $10 Nothing $10 $20 0.75 2.66 2.55 2.56 2.65 2.29 2.24

Physicians Plus HMO 7P $10 Nothing $6 $12

Unity Health Plans W4 $10 Nothing $5 $10 0.82 2.74 2.45 2.48 2.58 2.52 2.46

Valley Health Plan VH $10 Nothing $4 $8 0.91 2.86 2.59 2.57 2.69 2.68 2.69

Prescription Drugs, Generic, Brand shows what you pay for prescriptions when

you use a plan pharmacy. Some plans charge different amounts for refills (*), select

drugs and mail orders. In many plans, if you get the brand name instead of a generic

substitution, you also pay the difference between the two. Where a copay/coinsurance

are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. 

Satisfaction Indicators — See page 7 for a description

of these results. An (X) means the plan did not conduct

the survey as we asked.

Accreditation status — N = National Committee for

Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations