Plan Information

Harvard Pilgrim Health Care 2018-05-31T19:17:16+00:00
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Harvard Pilgrim Health Care

“Harvard Pilgrim is one of the nation’s leading not-for-profit health services companies that, along with its subsidiaries, is improving the well-being of its 2.7 million customers. Our flagship health plans in New England provide health coverage to 1.3 million members, while another 1.4 million individuals are served through Health Plans, Inc., a subsidiary that provides integrated care management, health coaching and plan administration solutions to self-funded employers nationwide.

Our mission is to improve the quality and value of health care for the people and communities we serve. We do that through the health plans we offer, as well as through the Harvard Pilgrim Health Care Institute , a research and teaching collaboration with Harvard Medical School; and the Harvard Pilgrim Health Care Foundation , which provides tools, training and leadership to help build healthy communities.”

From “About Us”

2018 Plan Information

NCQA Rating

Overall
3 out of 4 stars
This is the health insurer’s accreditation score from NCQA. NCQA evaluates the insurer’s quality measures and ongoing improvement.
Access and Service
3 out of 4 stars
NCQA evaluates how well the insurer provides access to needed care and with good customer service. To evaluate these activities, NCQA reviews the insurer’s appeals and denials, interviews the insurer’s staff and grades the results from consumer surveys.
Qualified Providers
3 out of 4 stars
NCQA evaluates the insurer’s efforts to confirm that each doctor is licensed and trained to practice medicine and that the health plan’s members are happy with their doctors. To evaluate these activities, NCQA uses records of doctors’ credentials, interviews the insurer’s staff, and grades the results from consumer surveys.
Staying Healthy
3 out of 4 stars
NCQA evaluates the insurer’s activities that help people maintain good health and avoid illness. To evaluate these activities, NCQA reviews the insurer’s records, grades independently verified clinical data and reviews materials sent to members.
Getting Better
3 out of 4 stars
NCQA evaluates health plan activities that help people recover from illness. To evaluate these activities, NCQA reviews the insurer’s records and interviews the insurer’s staff.
Living with Illness
3 out of 4 stars
NCQA evaluates health plan activities that help people manage chronic illness. NCQA grades independently verified clinical data and interviews the insurer’s staff.

About these ratings:
NCQA LogoThe National Committee for Quality Assurance (NCQA) is a private non-profit dedicated to improving health care quality. NCQA accredits and certifies health care organizations and recognizes physicians in key clinical areas. Visit www.ncqa.org to learn more.

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