PCP and Referral Requirement for Navigator by Tufts Health Plan Members

If you’ve already designated a PCP for yourself and your family, we thank you.

Members who do not currently have a PCP on file will be assigned one based on claims or location. If this applies to you, you will receive a letter notifying you of your assigned PCP.

If you have chosen a PCP for yourself or your dependents, but haven’t yet designated it to Tufts Health Plan, please get in touch with us in any of the following ways:

• By using your secure online account at mytuftshealthplan.com. After you log in, click “Change Primary Care Provider” in the top middle of the page, and follow the instructions.
• By calling Member Services at 1-800-870-9488.

What is a Primary Care Provider (PCP)?

A PCP is doctor, nurse practitioner, or physician’s assistant who provides most of your routine care and gives you referrals to other doctors or practitioners when you have a specific health issue or illness. A PCP can advocate for your health, keep records of the care you’ve received, and help you get the care you need.

A PCP is your main health care provider in non-emergency situations. Your PCP’s role is to:

• Provide preventive care and teach healthy lifestyle choices
• Identify and treat common medical conditions
• Assess the urgency of your medical problems and direct you to the best place for that care
• Make referrals to medical specialists when necessary

Obtaining Referrals

In most cases you will need to get a referral from your PCP when you need to see a specialist. Speak to your PCP’s office to make sure you have a referral in place whenever you are seeing a specialist.

In order to have the lowest out-of-pocket costs on your health plan, you must have a PCP on file with Tufts Health Plan and you must obtain PCP referrals to see specialists.