Affordable Health Insurance New Jersey
The State of NJ Department of Health and Senior Services (DHSS) is a clearinghouse for consumer, provider and payor information for health insurance coverage and medical care throughout the state. All ratings, reports, and recommendations are freely available via the agency’s Web site http://www.state.nj.us/health.
According to DHSS, NJ has two health coverage programs: The Individual Health Coverage Program and the Small Employer Health Benefits Program for employers with fewer than 50 employees. Individuals, regardless of their age or health status, are guaranteed renewable health coverage under standard individual health benefits plans designed by the Individual Health Coverage Program Board as well as under the “Basic and Essential” plans sold by carriers.
The performance of six NJ POS companies–Aetna, AmeriHealth, CIGNA, Health Net, Horizon and Oxford–are compared annually to the average NJ HMO and rated by consumers. According to results published in NJ’s HMO Performance Report, the six providers scored very closely to the average NJ HMO in the the areas of quality of care, good communication from doctors, the ability to obtain care as quickly as needed, claims processing, appointment scheduling, screening for cervical cancer and overall customer service. Oxford had significantly lower scores than the other providers in check-ups for new mothers and immunizations for children, and Amerihealth’s score for monitoring patients given medicine for depression fell an average of 20 percent below all other providers. Oxford scored much lower than its competitors in monitoring and controlling patients with high blood pressure and giving regular eye exams to members with diabetes.
DHSS also publishes comparative information on performance comparisons of all NJ acute care hospitals inthe annual NJ Hospital Performance Report. Hospital performance information is retrieved from patient medical records that are reviewed by the Centers for Medicare and Medicaid Services. Each hospital is rated on the percentage of patients who are correctly treated for heart attack, heart failure or pneumonia, and surgery. In the category of treating heart attack, these hospitals received a 100 percent overall rating: St. Clare’s Hospital-Sussex, Hackensack University Medical Center, Clara Maass Medical Center, AtlantiCare Regional Medical Center-City, and Deborah Heart and Lung Center.