Plan Information

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Harvard Pilgrim Health Care

“Harvard Pilgrim and its family of companies provide health benefit plans, programs and services to more than 3 million customers in New England and beyond. A leading not-for-profit health services company, we guide our members–and the communities we serve–to better health.

Founded by doctors nearly 50 years ago, we’re building on our legacy. In partnership with our expansive network of doctors and hospitals, we’re improving health outcomes and lowering costs through clinical quality and innovative care management.”

From “About Us”

2019 Plan Information

NCQA Accreditation Star Ratings

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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