Health Plan Decision

Helping Consumers Decide in Which Health Plan to Enroll

URAC accreditation is a national symbol of excellence, respected throughout the industry and by the federal and state governments as an assurance that a URAC-accredited organization meets rigorous standards of quality and operational integrity, with a strong focus on consumer protection and empowerment.

Health plans that receive the URAC accreditation seal of approval are among the best in the nation, giving consumers, employers, and government agencies the added confidence that an independent third party has evaluated and will continue to monitor the health plan for adherence to national accreditation standards.

By choosing a URAC-accredited health plan, consumers can rest assured that

  • Marketing and sales materials are accurate and clear.
  • Quality and safety of care are continuously reviewed and improved.
  • Providers are credentialed according to national standards.
  • A sufficient number and types of providers will always be available (including policies for accessing emergency and out-of-network coverage).
  • Access to services will not be denied on grounds other than medical necessity (plans are barred from rewarding employees for denying care).
  • Medical necessity decisions are made by qualified professionals based on the latest clinical guidelines.
  • Guidance and educational support for obtaining plan services are freely provided, in language that respects members’ diverse backgrounds.
  • Members’ opinions on their care and level of service are collected and used for quality improvement purposes.
  • Members will always have the right to appeal coverage denials and be informed of appeal decisions.
  • Members’ personal health information will always be kept confidential.
  • Mental health services and physical health services are offered on an equal basis.

Find out more about URAC’s Health Plan Accreditation Programs

Interested in accreditation?
Contact businessdevelopment@urac.org

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