Health and Dental Plan Programs

URAC’S Health Plan Accreditation: The Intersection of Quality and Value

Health plans that earn the URAC accreditation seal of approval are among the best in the nation, giving consumers, employers, and governmental agencies the added level of confidence that an independent third-party has evaluated and will continue to monitor the health plan for adherence to accreditation standards for quality and customer service. URAC accreditation is a nationally recognized symbol of excellence, respected throughout the industry and by the federal and state governments as an assurance that accredited organizations meet rigorous standards of quality and operational integrity that emphasize consumer protection and patient engagement.

URAC offers two accreditations for Health Plans:

URAC’s Health Plan Accreditation Advantage:

  • HHS approved, allowing URAC-accredited health plans to participate in Health Insurance Exchanges in all 50 States and the District of Columbia
  • Available for accreditation in the commercial and Medicaid markets
  • Cutting-edge quality measures and data analytics capabilities that minimize the burden and cost of data reporting while providing a level of analysis not available in other accreditation programs
  • Flexible design allows incorporation of state-specific standards and measures
  • Collaborative educational approach helps guide health plans in achieving accreditation
  • Provisional accreditation is available for new health plans
  • Pricing based on health plan size gives more plans opportunity to become accredited

Building Robust, Healthy Exchanges Through URAC Health Plan Accreditation

URAC has designed its Health Plan Accreditation to meet all requirements of the Affordable Care Act (ACA), allowing URAC-accredited health plans to participate in exchanges in all 50 states and the District of Columbia. The rigorous nature of URAC’s HHS-approved program also makes it an excellent accreditation choice for all markets, with the flexibility to add in any locally established exchange or state-mandated requirements.

Exchanges and their enrollees can rest assured that URAC-accredited health plans have had their operational and customer service infrastructure thoroughly reviewed, with a particular focus on ensuring that a plan meets the requirements of the ACA.

URAC’s Health Plan Accreditation includes key elements that support a health plan’s ability to meet the goals and requirements of the ACA including

  • Standards that ensure transparency and promote consumer protection and patient engagement
  • Requirements to meet key provisions of the Mental Health Parity and Addiction Equity Act of 2008
  • Support for health plans in their quality improvement activities related to medical loss ratio (ACA Section 2718)
  • Use of a robust and transparent scoring methodology
  • Accredited plans must report their performance on a standardized CAHPS survey
  • Reporting of clinical performance measures in a way that facilitates the use of meaningful, outcomes-based performance measures to improve care and consumer satisfaction

Learn How URAC’s Health Plan Accreditation Helps Consumers Decide in Which Plan to Enroll


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