NYSID Guide to HMOs

Worksheet to Choose an HMO

This worksheet can help you organize and evaluate information about the health insurers available to you. you can use information in this guide and in other materials you may have obtained from your employer and the health insurer to complete the worksheet.

	For All Types of Health Insurers						For HMOs Only
Access: Which HMOs are available where you live or work? For HMOs see Service Areas	Benefits: Which of the HMOs offer the benefits you want? Review benefit information from your employer or the health insurer.	Health Care Provider: Which of the HMOs include your preferred doctor or health care provider? Review the HMO's physician directories and call their Customer Service Departments.	Cost: Which of the HMOs fall within your price range? Review cost information from your employer or HMOs. Be sure to consider the amount of copays, coinsurance or decuctibles.	Complaints: How does the HMO rank, compared to other insurers? See Complaints.	Prompt Pay Complaints: How does the HMO rank, compared to other insurers? See Prompt Pay Complaints.	Internal Appeal: Which HMOs have low reversal rates? See Internal Appeals.	External Appeals: Which HMOs have low reversal rates? See External Appeals.	Access and Service: Look at the measures important to you. How do the HMOs you have chosen perform? See Access to Care and Service.	Staying Healthy & Living with Illness: Look at the measures important to you. How do the HMOs you have chosen perform? See Staying Healthy and Living with Illness.	Quality of Providers: Look at the measures important to you. How do the HMOs you have chosen perform? See Quality of Providers.	Grievances: Which HMOs have low reversal rates? See Grievances.