Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. Motorola


Motorola provides health insurance for its employees on a self-funded, self-administered basis. The distribution of staff in various plan types is as follows:

  • 16% in 23 HMOs;
  • 6% in managed indemnity;
  • 6% opt out and do not have Motorola-provided insurance; and
  • 72% are in a custom designed program to improve the clinical quality of service and patient satisfaction, called the Health Advantage Plan.

The Health Advantage Plan does not use a gatekeeper, capitation or deep discounting and somewhat resembles a PPO.

Employees are subject to annual enrollment periods, with about 2% switching plans annually.

As a self-administered plan, Motorola has installed both internal and external review processes, including the required ERISA appeal process. Motorola is unusual in being union-free nationwide (worldwide except where political processes require otherwise).

Motorola focuses on proactive systemic quality and service improvements rather than on individual grievances, which typically result from quality and/or service issues. It has a strong emphasis on system-wide evaluation of its health insurance plans. In evaluating its HMOs, the measures it considers are:

  1. Clinical quality - 35%;
  2. Customer satisfaction - 30%
  3. Financial - 20%; and
  4. Access - 15%.

As a result of this systematic evaluation, Motorola has decreased the number of HMOs it offers to employees from 35 to 23. The share of employees in HMOs has also declined from 35% to 16%, with greater take-up of the Health Advantage Plan. Motorola also offers employees a report card on HMOs, mainly based on the systematic evaluation, but also including HEDIS measures.

In addition, it undertakes annual customer satisfaction surveys with results as follows:

  • HMOs - improvement in customer satisfaction from 84 to 91%; and
  • Health Advantage Plan - customer satisfaction is about 93-94%.

Motorola has never lost a case brought to court through the external review process. It operates internal review processes using the standard ERISA process and standard HMO reviews as required by state regulation.

In conclusion, increasingly, companies like Motorola have developed policies and procedures designed to systematically improve clinical care and customer satisfaction to attract and retain employees.