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Healthcare Plan Information

 

Overview - Ensuring Quality Healthcare

What is quality healthcare?

Great question.

Quality healthcare is: Better Care and Better Health at Lower Cost.

All FEHB plans support quality with educated health professionals, efficient hospitals, nursing homes, clinics, accurate medical records, and open communication. OPM's definition and evaluation of quality care is strengthened by your health plan selection, feedback, and health improvement.

Why is quality healthcare important to me?

We can suggest a few reasons...

The plan you choose can make a difference in your health! A quality health plan will:

  • Improve healthcare outcomes by using evidence-based research and technology to promote the selection and delivery of the best possible care.
  • Reduce unnecessary health care costs.

How does OPM help me select quality healthcare?

We give you our best!

We work with health plans to advance healthcare delivery, concentrating on common health conditions to provide overall better patient health. Learn more about the quality evaluation system.

We offer health plans that build a positive healthcare experience, responding attentively to patient feedback regarding doctors and services. Learn more about member experiences and how they're reported.

And

We incentivize health plans to slow the growth of healthcare costs, so that all enrollees can afford quality care (and perhaps save more money to take that family vacation...)

I need additional resources to help make my decision.

We're here to help.

Below, you will find links to non-OPM websites that provide information on assuring quality in health care.

About Member Survey

Each year Federal Employees Health Benefits (FEHB) plans survey a sample of plan members to evaluate their health plan experiences.

OPM reports each health plan's scores on the survey questions listed below. We show the percentage of satisfied members on a scale of 0 to 100 and the national average for each question. This will let you compare plans to other plans, and the national average.

Since we offer a variety of plan types (HMO plans, FFS/PPO plans, HDHP plans, and CDHP plans), we calculate a separate national average for each plan type.

You can find survey results for the following key areas of member satisfaction in the Guide to Federal Benefits:

  • Overall Plan Satisfaction - This measure is based on the question, "Using any number from 0 to 10, where 0 is the worst health plan possible and 10 is the best health plan possible, what number would you use to rate your health plan?" We report the percent of respondents who rated their plan 8 or higher.
  • Getting Needed Care - How often was it easy to get an appointment, the care tests, or treatment you thought you needed through your health plan?
  • Getting Care Quickly - When you needed care right away, how often did you get care as soon as you thought you needed? Not counting the times you needed care right away, how often did you get an appointment at a doctor's office or clinic as soon as you thought you needed?
  • How Well Doctors Communicate - How often did your personal doctor explain things in a way that was easy to understand? How often did your personal doctor listen carefully to you, show respect for what you had to say, and spend enough time with you?
  • Customer Service - How often did the written materials or the Internet provide information you needed about how your health plan works? How often did your health plan's customer service give you the information or help you needed?
  • Claims Processing - How often did your health plan handle your claims quickly and correctly?
  • Plan Information on Costs - How often were you able to find out from your health plan how much you would have to pay for a health care service or equipment, or for specific prescription drug medicines?

Generally, new plans and those with fewer than 500 FEHB enrollees do not participate in the survey. Therefore, some of the plans listed in the Guide will not have survey data.

Member Survey Results

Quality Scoring Results

Quality Healthcare for the Federal Population

The Office of Personnel Management (OPM) is proud to provide quality healthcare choices. To help you select a health plan that meets your needs and your family’s healthcare needs, we developed a quality evaluation system that allows you to gauge health plan performance for significant health issues, such as cancer, heart disease, diabetes, and mental health.

OPM evaluates health plan performance across nine major health issues in the FEHB population. View the health issues in the table of contents to view each health plans’ performance compared to United States National Health Maintenance Organization (HMO)Preferred Provider Organization (PPO)Point of Service Organization (POS), and All Lines of Business (LOB) Averages.

View a detailed explanation of OPM’s health plan evaluation system and scoring process.

Healthcare Effectiveness Data and Information Set (HEDIS®), source of the data presented on this web page, is a registered trademark of the National Committee for Quality Assurance (NCQA). View more information on the collection and assessment of HEDIS.

The HEDIS® measures and specifications were developed by and are owned by the National Committee for Quality Assurance ("NCQA"). The HEDIS measures and specifications are not clinical guidelines and do not establish standards of medical care. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures or any data or rates calculated using the HEDIS measures and specifications and NCQA has no liability to anyone who relies on such measures or specifications. © 2012-2015 National Committee for Quality Assurance, all rights reserved.

The data contained herein is protected by copyright and other intellectual property laws or treatises. Reproduction or use of the data requires permission of NCQA and is subject to a license at the discretion of NCQA. Unauthorized copying or use if prohibited.

The Status list has been updated.


Healthcare Quality Scores and Status Key: Exemplary Most Improved Above National Average Below National Average National Average
Status
Plan Name
Breast Cancer
Blood Sugar Screening
Mental Health
Blood Pressure
Prenatal Care
Back Pain
Well Child Visits
Athsma Medication Management
Hospital Readmissions (Ratio)
Aetna Life Insurance Company - California 70%Equal To National Average 84%Below National Average 56%Above National Average 44%Below National Average 89%Below National Average 82%Above National Average 73%Below National Average 51%Above National Average 0.62Below National Average
Aetna Life Insurance Company - Colorado 69%Below National Average 88%Equal To National Average 53%Above National Average 54%Below National Average 89%Below National Average 79%Above National Average 82%Above National Average 46%Below National Average 0.66Below National Average
Aetna Life Insurance Company - Illinois 70%Equal To National Average 89%Above National Average 57%Above National Average 47%Below National Average 87%Below National Average 73%Below National Average 87%Above National Average 58%Above National Average 0.67Below National Average
Aetna Life Insurance Company - Maryland/District of Columbia 70%Equal To National Average 84%Below National Average 57%Above National Average 58%Above National Average 88%Below National Average 72%Below National Average 85%Above National Average 55%Above National Average 0.67Below National Average
Aetna Life Insurance Company - New Jersey 68%Below National Average 86%Below National Average 62%Above National Average 45%Below National Average 92%Below National Average 72%Below National Average 85%Above National Average 54%Above National Average 0.71Equal To National Average
Exemplary Aetna Life Insurance Company - New York 69%Below National Average 89%Above National Average 60%Above National Average 58%Above National Average 90%Below National Average 74%Below National Average 86%Above National Average 50%Above National Average 0.66Below National Average
Aetna Life Insurance Company - Pennsylvania 71%Above National Average 83%Below National Average 59%Above National Average 60%Above National Average 89%Below National Average 75%Equal To National Average 85%Above National Average 57%Above National Average 0.67Below National Average
Aetna Life Insurance Company - Texas 68%Below National Average 92%Above National Average 49%Below National Average 51%Below National Average 90%Below National Average 69%Below National Average 78%Above National Average 48%Above National Average 0.73Above National Average
Aetna Life Insurance Company - Virginia 72%Above National Average 92%Above National Average 49%Below National Average 55%Below National Average 86%Below National Average 70%Below National Average 86%Above National Average 57%Above National Average 0.77Above National Average
Aetna Life Insurance Company - Washington 69%Below National Average 89%Above National Average 46%Below National Average 46%Below National Average 80%Below National Average 79%Above National Average 71%Below National Average 46%Below National Average 0.77Above National Average
Aetna Life Insurance Company - Wisconsin 73%Above National Average 90%Above National Average 50%Equal To National Average 44%Below National Average 59%Below National Average 74%Below National Average 80%Above National Average 55%Above National Average 0.64Below National Average
Aetna Open Access - Arizona 67%Below National Average 89%Below National Average 48%Below National Average 57%Below National Average 88%Below National Average 72%Below National Average 68%Below National Average 45%Above National Average 0.82Above National Average
Aetna Open Access - California 71%Below National Average 87%Below National Average 46%Below National Average 41%Below National Average 75%Below National Average 79%Above National Average 0%Equal To National Average 49%Above National Average 0.66Below National Average
Aetna Open Access - Delaware, New Jersery, Pennsylvania 71%Below National Average 86%Below National Average 54%Above National Average 62%Below National Average 87%Below National Average 79%Above National Average 72%Below National Average 59%Above National Average 0.88Above National Average
Aetna Open Access - District of Columbia 69%Below National Average 85%Below National Average 48%Below National Average 53%Below National Average 90%Below National Average 70%Below National Average 74%Below National Average 53%Above National Average 0.67Below National Average
Aetna Open Access - Georgia 68%Below National Average 90%Equal To National Average 47%Below National Average 58%Below National Average 91%Below National Average 66%Below National Average 73%Below National Average 47%Above National Average 0.76Above National Average
Aetna Open Access - New Jersey 69%Below National Average 88%Below National Average 57%Above National Average 55%Below National Average 88%Below National Average 75%Equal To National Average 70%Below National Average 55%Above National Average 0.7Below National Average
Aetna Open Access - New York 67%Below National Average 88%Below National Average 59%Above National Average 52%Below National Average 86%Below National Average 80%Above National Average 76%Below National Average 50%Above National Average 0.57Below National Average
Aetna Open Access - Pennsylvania 68%Below National Average 84%Below National Average 56%Above National Average 57%Below National Average 90%Below National Average 75%Equal To National Average 72%Below National Average 50%Above National Average 0.67Below National Average
Aetna Open Access - Tennessee 63%Below National Average 85%Below National Average 0%Equal To National Average 64%Above National Average 85%Below National Average 73%Below National Average 0%Equal To National Average 0%Equal To National Average 0.39Below National Average
Altius Health Plans 66%Below National Average 91%Above National Average 49%Below National Average 63%Equal To National Average 85%Below National Average 80%Above National Average 69%Below National Average 43%Below National Average 0.59Below National Average
Anthem Blue Cross Select HMO 77%Above National Average 89%Below National Average 54%Above National Average 60%Below National Average 90%Below National Average 78%Above National Average 56%Below National Average 38%Below National Average 0.65Below National Average
APWU Health Plan 64%Below National Average 80%Below National Average 29%Below National Average 40%Below National Average 58%Below National Average 73%Below National Average 58%Below National Average 48%Above National Average 0.92Above National Average
APWU Health Plan - CDHP 61%Below National Average 91%Above National Average 37%Below National Average 52%Below National Average 76%Below National Average 76%Above National Average 64%Below National Average 38%Below National Average 0.88Above National Average
AultCare HMO 75%Equal To National Average 94%Above National Average 0%Equal To National Average 70%Above National Average 0%Equal To National Average 82%Above National Average 0%Equal To National Average 0%Equal To National Average 1.24Above National Average
Most Improved AvMed Health Plans 76%Above National Average 89%Below National Average 35%Below National Average 64%Above National Average 93%Below National Average 65%Below National Average 85%Above National Average 51%Above National Average 0.82Above National Average
Blue Cross and Blue Shield of New Mexico 64%Below National Average 86%Below National Average 44%Below National Average 50%Below National Average 82%Below National Average 78%Above National Average 69%Below National Average 39%Below National Average 0.73Equal To National Average
Blue Cross and Blue Shield Service Benefit Plan 71%Above National Average 92%Above National Average 51%Above National Average 35%Below National Average 80%Below National Average 73%Below National Average 82%Above National Average 46%Below National Average 0.78Above National Average
Blue Preferred Plus POS 70%Below National Average 90%Equal To National Average 34%Below National Average 68%Above National Average 90%Below National Average 75%Equal To National Average 79%Above National Average 46%Above National Average 0.59Below National Average
Blue Shield of CA Access+HMO 76%Above National Average 90%Equal To National Average 73%Above National Average 65%Above National Average 87%Below National Average 78%Above National Average 50%Below National Average 40%Below National Average 0.72Above National Average
Most Improved Bluecare Network of Michigan 81%Above National Average 92%Above National Average 75%Above National Average 68%Above National Average 93%Below National Average 74%Below National Average 80%Above National Average 46%Above National Average 0.72Below National Average
Calvos Selectcare 0%Equal To National Average 86%Below National Average 0%Equal To National Average 0%Below National Average 0%Equal To National Average 0%Above National Average 0%Equal To National Average 0%Equal To National Average 1.56Above National Average
Capital Health Plan 83%Above National Average 95%Above National Average 89%Above National Average 74%Above National Average 93%Below National Average 76%Below National Average 87%Above National Average 32%Below National Average 0.69Below National Average
CareFirst BlueChoice 72%Below National Average 89%Below National Average 55%Above National Average 0%Equal To National Average 80%Below National Average 72%Below National Average 82%Above National Average 47%Above National Average 0.66Below National Average
Exemplary CDPHP Universal Benefits, Inc. 76%Above National Average 92%Above National Average 65%Above National Average 74%Above National Average 93%Below National Average 77%Above National Average 90%Above National Average 44%Below National Average 0.76Above National Average
Compass Rose Health Plan 0%Equal To National Average 91%Above National Average 32%Below National Average 51%Below National Average 54%Below National Average 75%Equal To National Average 0%Equal To National Average 0%Equal To National Average 0Below National Average
Coventry Health Care of Iowa 67%Below National Average 91%Above National Average 45%Below National Average 72%Above National Average 78%Below National Average 77%Above National Average 62%Below National Average 44%Below National Average 0.68Below National Average
Coventry Health Care of Kansas 71%Below National Average 92%Above National Average 70%Above National Average 66%Above National Average 81%Below National Average 77%Above National Average 73%Below National Average 43%Below National Average 0.7Below National Average
Coventry Health Care of Louisiana 76%Above National Average 87%Below National Average 24%Below National Average 63%Equal To National Average 86%Below National Average 65%Below National Average 74%Below National Average 41%Below National Average 0.77Above National Average
Coventry Health Plan of Florida 79%Above National Average 87%Below National Average 0%Equal To National Average 51%Below National Average 90%Below National Average 62%Below National Average 84%Above National Average 38%Below National Average 0.93Above National Average
Exemplary Dean Health Plan 79%Above National Average 95%Above National Average 67%Above National Average 82%Above National Average 93%Below National Average 83%Above National Average 81%Above National Average 53%Above National Average 0.84Above National Average
Fallon community Health Plan 84%Above National Average 96%Above National Average 69%Above National Average 70%Above National Average 93%Below National Average 76%Above National Average 93%Above National Average 34%Below National Average 0.68Below National Average
Firstcare 69%Below National Average 86%Below National Average 0%Equal To National Average 51%Below National Average 88%Below National Average 73%Below National Average 59%Below National Average 40%Below National Average 0.55Below National Average
Foreign Service Benefit Plan 68%Below National Average 82%Below National Average 53%Above National Average 52%Below National Average 43%Below National Average 79%Above National Average 34%Below National Average 60%Above National Average 1.16Above National Average
GEHA Benefit Plan 65%Below National Average 85%Below National Average 44%Below National Average 47%Below National Average 71%Below National Average 76%Above National Average 68%Below National Average 48%Above National Average 0.82Above National Average
Exemplary Geisinger Health Plan 75%Above National Average 90%Equal To National Average 79%Above National Average 73%Above National Average 94%Below National Average 79%Above National Average 78%Below National Average 46%Above National Average 0.67Below National Average
GHI Health Plan 63%Below National Average 86%Below National Average 0%Equal To National Average 24%Below National Average 86%Below National Average 76%Above National Average 76%Below National Average 40%Below National Average 0.89Above National Average
Globalhealth, Inc. 69%Below National Average 85%Below National Average 0%Equal To National Average 49%Below National Average 73%Below National Average 69%Below National Average 63%Below National Average 52%Above National Average 0.52Below National Average
Exemplary Grand Valley Health Plan 79%Above National Average 98%Above National Average 0%Equal To National Average 69%Above National Average 91%Below National Average 82%Above National Average 0%Equal To National Average 0%Equal To National Average 0.69Below National Average
Exemplary Group Health Cooperative - Idaho, Washington 78%Above National Average 94%Above National Average 68%Above National Average 70%Above National Average 92%Below National Average 82%Above National Average 75%Below National Average 49%Above National Average 0.72Below National Average
Group Health Cooperative - Wisconsin 80%Above National Average 92%Above National Average 80%Above National Average 76%Above National Average 94%Below National Average 88%Above National Average 88%Above National Average 42%Below National Average 0.91Above National Average
Health Alliance HMO 80%Above National Average 91%Above National Average 45%Below National Average 71%Above National Average 88%Below National Average 77%Above National Average 86%Above National Average 49%Above National Average 0.82Above National Average
Health Alliance Plan 79%Above National Average 88%Below National Average 62%Above National Average 64%Above National Average 85%Below National Average 72%Below National Average 78%Below National Average 43%Below National Average 0.85Above National Average
Health Net of Arizona, Inc. 62%Below National Average 88%Below National Average 40%Below National Average 66%Below National Average 86%Below National Average 76%Below National Average 69%Below National Average 35%Below National Average 0.8Above National Average
Health Net of California 72%Below National Average 87%Below National Average 49%Below National Average 66%Above National Average 84%Below National Average 80%Above National Average 50%Below National Average 40%Below National Average 0.83Above National Average
Health Plan of Nevada 70%Below National Average 84%Below National Average 68%Above National Average 66%Above National Average 84%Below National Average 81%Above National Average 72%Below National Average 26%Below National Average 0.77Above National Average
Exemplary HealthAmerica Pennsylvania & HealthAmerica Pennsylvania HDHP 78%Above National Average 93%Above National Average 55%Above National Average 73%Above National Average 89%Below National Average 74%Below National Average 92%Above National Average 55%Above National Average 0.75Above National Average
Exemplary HealthPartners High and Standard Option 79%Above National Average 96%Above National Average 65%Above National Average 76%Above National Average 98%Below National Average 84%Above National Average 82%Above National Average 48%Above National Average 0.69Below National Average
Exemplary HealthPlus of Michigan 84%Above National Average 92%Above National Average 65%Above National Average 62%Below National Average 93%Below National Average 76%Above National Average 82%Above National Average 54%Above National Average 0.72Above National Average
HealthSpan Integrated Care 77%Above National Average 95%Above National Average 52%Below National Average 70%Above National Average 63%Below National Average 85%Above National Average 87%Above National Average 12%Below National Average 0.54Below National Average
HIP Health of Greater New York 74%Equal To National Average 92%Above National Average 51%Below National Average 57%Below National Average 82%Below National Average 79%Above National Average 65%Below National Average 44%Below National Average 0.86Above National Average
Exemplary HMSA 80%Above National Average 91%Above National Average 52%Equal To National Average 59%Below National Average 86%Below National Average 82%Above National Average 84%Above National Average 50%Above National Average 0.62Below National Average
Humana Benefit Plan of Illinois, Inc. 70%Below National Average 91%Equal To National Average 0%Equal To National Average 75%Above National Average 0%Equal To National Average 0%Above National Average 0%Equal To National Average 0%Equal To National Average 0.28Below National Average
Humana Benefit Plan of Louisiana 77%Above National Average 88%Below National Average 30%Below National Average 64%Above National Average 85%Below National Average 64%Below National Average 82%Above National Average 33%Below National Average 0.82Above National Average
Humana Employers Health of Georgia, Inc. 70%Below National Average 88%Below National Average 38%Below National Average 56%Below National Average 81%Below National Average 66%Below National Average 72%Below National Average 34%Below National Average 0.67Below National Average
Humana Health Paln of Texas - San Antonio 68%Below National Average 87%Below National Average 31%Below National Average 63%Equal To National Average 87%Below National Average 70%Below National Average 75%Below National Average 34%Below National Average 0.6Below National Average
Humana Health Plan of Ohio 69%Below National Average 93%Above National Average 52%Equal To National Average 58%Below National Average 84%Below National Average 68%Below National Average 87%Above National Average 43%Below National Average 0.74Above National Average
Humana Health Plan of Texas - Austin 68%Below National Average 90%Equal To National Average 23%Below National Average 60%Below National Average 83%Below National Average 75%Equal To National Average 79%Below National Average 34%Below National Average 0.62Below National Average
Humana Health Plan of Texas - Corpus Christi 69%Below National Average 90%Equal To National Average 0%Equal To National Average 56%Below National Average 84%Below National Average 71%Below National Average 60%Below National Average 40%Below National Average 0.52Below National Average
Humana Health Plan of Texas - Houston 63%Below National Average 88%Below National Average 31%Below National Average 49%Below National Average 86%Below National Average 68%Below National Average 72%Below National Average 35%Below National Average 0.62Below National Average
Most Improved Humana Health Plan, Inc - Illinois 71%Below National Average 89%Below National Average 40%Below National Average 67%Above National Average 93%Below National Average 76%Above National Average 75%Below National Average 36%Below National Average 0.65Below National Average
Humana Health Plan, Inc - Kentucky 74%Equal To National Average 92%Above National Average 46%Below National Average 55%Below National Average 79%Below National Average 70%Below National Average 84%Above National Average 46%Above National Average 0.69Below National Average
Humana Health Plan, Inc. - Arizona 66%Below National Average 89%Below National Average 34%Below National Average 61%Below National Average 85%Below National Average 71%Below National Average 69%Below National Average 43%Below National Average 0.57Below National Average
Humana Health Plan, Inc. - Kansas City 68%Below National Average 91%Above National Average 33%Below National Average 67%Above National Average 83%Below National Average 62%Below National Average 0%Equal To National Average 34%Below National Average 0.68Below National Average
Humana Health Plan, Inc. - Tennessee 74%Equal To National Average 91%Above National Average 44%Below National Average 59%Below National Average 88%Below National Average 65%Below National Average 82%Above National Average 47%Above National Average 0.57Below National Average
Humana Health Plans of Puerto Rico, Inc. 67%Below National Average 83%Below National Average 3%Below National Average 49%Below National Average 74%Below National Average 80%Above National Average 11%Below National Average 20%Below National Average 0.6Below National Average
Humana Insurance Company - Texas 68%Below National Average 85%Below National Average 32%Below National Average 56%Below National Average 88%Below National Average 72%Below National Average 71%Below National Average 35%Below National Average 0.63Below National Average
Humana Medical Plan, Inc. - Florida 75%Above National Average 92%Above National Average 32%Below National Average 53%Below National Average 83%Below National Average 65%Below National Average 83%Above National Average 40%Below National Average 0.71Equal To National Average
Independent Health Association 75%Above National Average 87%Below National Average 66%Above National Average 73%Above National Average 97%Below National Average 85%Above National Average 90%Above National Average 35%Below National Average 0.74Above National Average
Kaiser Foudnation Health Plan of Hawaii 85%Above National Average 95%Above National Average 71%Above National Average 78%Above National Average 95%Below National Average 84%Above National Average 93%Above National Average 31%Below National Average 0.73Below National Average
Exemplary Kaiser Foundation Health Plan Mid-Atlantic States 90%Above National Average 95%Above National Average 64%Above National Average 91%Above National Average 98%Below National Average 83%Above National Average 85%Above National Average 48%Above National Average 0.72Below National Average
Exemplary Kaiser Foundation Health Plan of Colorado 82%Above National Average 96%Above National Average 68%Above National Average 89%Above National Average 97%Below National Average 86%Above National Average 86%Above National Average 66%Above National Average 0.58Below National Average
Kaiser Foundation Health Plan of Georgia 77%Above National Average 93%Above National Average 63%Above National Average 82%Above National Average 93%Below National Average 82%Above National Average 88%Above National Average 27%Below National Average 0.69Below National Average
Kaiser Foundation Health Plan of Northern California 87%Above National Average 95%Above National Average 76%Above National Average 87%Above National Average 96%Below National Average 90%Above National Average 86%Above National Average 40%Below National Average 0.94Above National Average
Kaiser Foundation Health Plan of Northwest 85%Above National Average 96%Above National Average 65%Above National Average 84%Above National Average 96%Below National Average 86%Above National Average 94%Above National Average 37%Below National Average 0.59Below National Average
Kaiser Foundation Health Plan of Southern California 88%Above National Average 94%Above National Average 76%Above National Average 86%Above National Average 97%Below National Average 90%Above National Average 87%Above National Average 42%Below National Average 0.92Above National Average
Most Improved KPS Health Plans 70%Equal To National Average 89%Above National Average 0%Equal To National Average 57%Equal To National Average 84%Below National Average 85%Above National Average 71%Below National Average 55%Above National Average 0.68Below National Average
M.D. IPA 63%Below National Average 85%Below National Average 53%Above National Average 51%Below National Average 78%Below National Average 76%Above National Average 86%Above National Average 45%Below National Average 0.94Above National Average
MercyCare HMO 72%Below National Average 93%Above National Average 0%Equal To National Average 64%Below National Average 93%Below National Average 83%Above National Average 81%Above National Average 53%Above National Average 1.21Above National Average
MHBP - Std 65%Below National Average 85%Below National Average 41%Below National Average 49%Below National Average 50%Below National Average 75%Equal To National Average 70%Below National Average 59%Above National Average 0.88Above National Average
Exemplary MVP Health Care 75%Above National Average 91%Above National Average 59%Above National Average 76%Above National Average 95%Below National Average 71%Below National Average 89%Above National Average 48%Above National Average 0.72Above National Average
NALC 65%Below National Average 88%Equal To National Average 51%Above National Average 30%Below National Average 67%Below National Average 76%Above National Average 69%Below National Average 78%Above National Average 0.65Below National Average
Panama Canal Area Benefit Plan 60%Below National Average 98%Above National Average 0%Equal To National Average 67%Above National Average 0%Equal To National Average 0%Equal To National Average 0%Equal To National Average 0%Equal To National Average 1.76Above National Average
Physicians Plus 81%Above National Average 96%Above National Average 80%Above National Average 69%Above National Average 83%Below National Average 78%Above National Average 86%Above National Average 48%Above National Average 0.76Above National Average
Piedmont Community Healthcare 52%Below National Average 0%Equal To National Average 0%Equal To National Average 0%Equal To National Average 0%Equal To National Average 0%Equal To National Average 0%Equal To National Average 0%Equal To National Average 2.38Above National Average
Presbyterian Health Plan 69%Below National Average 89%Equal To National Average 47%Below National Average 58%Below National Average 85%Below National Average 79%Above National Average 76%Below National Average 38%Below National Average 0.69Below National Average
QualChoice 63%Below National Average 84%Below National Average 12%Below National Average 0%Equal To National Average 0%Above National Average 69%Below National Average 64%Below National Average 37%Below National Average 0.67Below National Average
Rural Carrier Benefit Plan 69%Below National Average 88%Equal To National Average 32%Below National Average 46%Below National Average 34%Below National Average 80%Above National Average 0%Equal To National Average 84%Above National Average 0.74Above National Average
SAMBA 69%Below National Average 84%Below National Average 9%Below National Average 49%Below National Average 51%Below National Average 74%Below National Average 57%Below National Average 63%Above National Average 1.03Above National Average
Sanford Health Plan & Sanford Heart of Amercia Health Plan 77%Above National Average 95%Above National Average 41%Below National Average 76%Above National Average 90%Below National Average 88%Above National Average 69%Below National Average 45%Above National Average 0.88Above National Average
Scott & White Health Plan 76%Above National Average 94%Above National Average 43%Below National Average 53%Below National Average 89%Below National Average 73%Below National Average 64%Below National Average 46%Above National Average 0.84Above National Average
SelectHealth 70%Below National Average 92%Above National Average 49%Below National Average 72%Above National Average 95%Below National Average 77%Above National Average 77%Below National Average 38%Below National Average 0.67Below National Average
SelectHealth 57%Below National Average 88%Below National Average 54%Above National Average 63%Equal To National Average 13%Below National Average 82%Above National Average 59%Below National Average 0%Equal To National Average 1.07Above National Average
TakeCare 59%Below National Average 79%Below National Average 0%Equal To National Average 62%Below National Average 85%Below National Average 86%Above National Average 30%Below National Average 27%Below National Average 1.13Above National Average
The Health Plan of the Upper Ohio Valley 75%Equal To National Average 88%Below National Average 32%Below National Average 68%Above National Average 92%Below National Average 73%Below National Average 89%Above National Average 47%Above National Average 0.84Above National Average
Triple-S Salud, Inc. 64%Below National Average 80%Below National Average 21%Below National Average 38%Below National Average 82%Below National Average 91%Above National Average 7%Below National Average 30%Below National Average 0.5Below National Average
Union Health Service 57%Below National Average 91%Equal To National Average 0%Equal To National Average 0%Equal To National Average 0%Above National Average 87%Above National Average 0%Equal To National Average 0%Equal To National Average 0Above National Average
UnitedHealthcare Benefits of Texas, Inc. 61%Below National Average 84%Below National Average 0%Equal To National Average 70%Above National Average 0%Above National Average 0%Above National Average 0%Equal To National Average 0%Equal To National Average 0.39Below National Average
UnitedHealthcare of California 76%Above National Average 91%Equal To National Average 66%Above National Average 66%Below National Average 84%Below National Average 81%Above National Average 50%Below National Average 37%Below National Average 0.77Above National Average
UnitedHealthcare Plan of the River Valley Inc. 68%Below National Average 88%Below National Average 46%Below National Average 55%Below National Average 83%Below National Average 77%Above National Average 72%Below National Average 41%Below National Average 0.75Above National Average
Exemplary UPMC Health Coverage, Inc. 76%Above National Average 91%Equal To National Average 68%Above National Average 74%Above National Average 96%Below National Average 75%Below National Average 95%Above National Average 51%Above National Average 0.76Above National Average
Exemplary UPMC Health Options 72%Above National Average 91%Above National Average 67%Above National Average 72%Above National Average 96%Below National Average 83%Above National Average 86%Above National Average 48%Above National Average 0.68Below National Average

Quality Scoring Process

OPM’s Health Plan Evaluation and Scoring Process

For nine major health issues, OPM collects and analyses Healthcare Effectiveness Data and Information Set (HEDIS*) metrics. HEDIS metrics are a set of standardized performance measures that allow you to compare Federal Employees Health Benefits (FEHB) health plan performance to the National Average health plan performance.

For each major health issue, Health Maintenance Organization (HMO)Preferred Provider Organization (PPO), Point of Service Organization (POS), and All Lines of Business (LOB) are compared to applicable performance scores.

Top performing health plans earn the highest recognition of 'Exemplary' status, and are marked with this symbol Exemplary symbol. Health plans that demonstrate significant progress earn 'Most Improved' status, and are marked with this symbol Most Improved symbol.

* HEDIS is sponsored, supported, and maintained by the National Committee for Quality Assurance (NCQA). More information on HEDIS and NCQA.

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