Tufts Health Plan and Harvard Pilgrim Health Care Combination

Frequently Asked Questions (FAQ)

Last Updated July 21, 2021

The new organization will strive to create a preeminent, nonprofit regional health services organization focused on improving affordability, increasing access to high quality health care, and enhancing member experience.

The new organization will serve close to 2.2 million members in Massachusetts, Maine, Connecticut, New Hampshire and Rhode Island; offering employer-sponsored plans, Medicare and Medicaid plans; Qualified Health Plans, and plans for those who are dually eligible for Medicare and Medicaid.

Below are frequently asked questions which will be updated as new information becomes available. Please check back here for most recent updates.

General | New Business Quotes + Renewals | Service | Rates + Underwriting
Products + Offerings | Member Impact | Broker Compensation

General

Why have Tufts Health Plan and Harvard Pilgrim combined? What value will the new organization bring to the marketplace?

The combination of Tufts Health Plan and Harvard Pilgrim brings together two highly regarded health care companies known for delivering excellence in quality, service, innovation and commitment to the community. Leveraging the individual strengths and “best in class” capabilities of our organizations, the newly combined organization seeks to improve the health of our communities and redefine the role a health plan plays in expanding access, containing costs, and working toward better health outcomes for the customers and the communities we serve.

Who will lead the new organization?

Cain Hayes will serve as chief executive officer and Michael Carson will serve as president of the new organization and oversee the Commercial, Medicare, and Medicaid/Government subsidized lines of business. We are also excited to share the names and roles of several, talented leaders who will lead and support the Commercial business for the new, combined organization including:

  • Beth Roberts, Head of Commercial Business
  • Patty Blake, Head of Senior Programs/Medicare
  • Jean Yang, Head of Public Plans
  • Deb Hodges, President of Health Plans, Inc.
  • Tracey Carter, Head of Actuarial


New Business Quotes and Renewals

How will quotes and renewals be handled after the transaction is closed?

For 2021, brokers should continue to request new business quotes and renewals as they always have for Harvard Pilgrim and Tufts Health Plan business.

I received a Tufts Health Plan or Harvard Pilgrim quote/renewal before the close for a 2021 effective date? Will that quote still be valid now that the companies have formally combined, or will you be

Both Harvard Pilgrim and Tufts Health Plan will honor all quotes and renewals that have been delivered to brokers and accounts.

How will RFPs be handled now that the companies have combined?

Brokers and consultants will submit the RFPs to either or both organizations and we will coordinate our responses to ensure we are meeting the needs of the prospective client.

Will there be a change to the process for selling business through intermediaries?

There will be no change to processes for selling through intermediaries for the near term.


Service

Will my sales and account representative assignments change?

In Massachusetts, the current Tufts Health Plan and Harvard Pilgrim sales and account representatives will stay the same in the near term. If or when there are any changes, you will be notified well in advance.

Will there be any impact to regional sales teams outside of Massachusetts?

There are no immediate changes planned for the regional sales teams in New Hampshire, Maine, Connecticut or Rhode Island. The one exception is for Tufts Health Freedom Plan in New Hampshire, which has been sold to United Healthcare in connection with the combination.  Please see the separate communications regarding the sale or visit the Tufts Health Freedom Plan website for more information.

Will the broker service model change?

There will be no changes in the broker service model for either organization throughout 2021.  As always, we will be evaluating our service models to ensure we are bringing you the most efficient resources and support to manage your clients. 

For accounts that offer both Harvard Pilgrim and Tufts Health Plan, will there be any changes in service as a result of the combination?

Service for Harvard Pilgrim and Tufts Health Plan accounts and customers will continue as it is today.

Will account reporting or broker compensation tools change?

Harvard Pilgrim and Tufts Health Plan will continue to use existing account reporting tools and broker compensation programs throughout 2021.You will be notified of any changes well in advance.

How will the day-to-day administration of plans be impacted?

There will be no changes or impacts to the administration of your plans through the end of 2021.

If my client accepts the quote or renewal, to whom do they make the check payable?

Checks should be sent to the same name and address currently used. We will notify you well in advance if that changes.

Where do I send the enrollment information? Harvard Pilgrim and Tufts Health Plan have different due dates. Which date is applicable?

Please send enrollment information to the same address currently used by, and the same deadlines currently in place for, Tufts Health Plan and Harvard Pilgrim.


Rates and Underwriting

Will the underwriting approach or rules change now that the combination is complete?
  • For 2021, small group underwriting remains unchanged for both Harvard Pilgrim and Tufts Health Plan. Product pairing and underwriting rules will remain intact through the end of 2021.
  • For 2021 large group business, we are working to deliver the best products and rates to your clients and will be reviewing underwriting rules in early 2021.
Will the new organization have separate or unified rates?

As Tufts Health Plan and Harvard Pilgrim work to unify pricing methodologies into a single rating process, the combined organization will work to align pricing to the extent possible during 2021.  

If I have separate quotes from each organization, can I pick the best one?

Yes, you can choose any quote from Tufts Health Plan or Harvard Pilgrim. Keep in mind that quotes are not interchangeable between Tufts Health Plan and Harvard Pilgrim. The quotes you receive from Tufts Health Plan are only applicable to their specific products and services. The quotes you receive from Harvard Pilgrim are only applicable to their products and services.

Who do I contact if I have questions about a Tufts Health Plan or Harvard Pilgrim quote or renewal?

You will continue to contact your current Harvard Pilgrim or Tufts Health Plan sales or account representative. If or when there are any changes, you will be notified well in advance.

How will premiums be impacted by the combination?

Part of our new organization’s mission is bringing increased affordability to our markets. We are committed to delivering on this through improved care delivery, member engagement and efficiencies gained through the scale of the combined organization. 


Products and Offerings

How long will Harvard Pilgrim and Tufts Health Plan products be available for renewals?

Both organizations will continue to offer all products and services through 2021. We are reviewing our product portfolios and we anticipate plans for renewal and new business as a combined organization for 2022 and beyond. 

When will I see changes in products due to the combination?

You and your clients will not see changes in products or offerings due to the combination until 2022 or 2023. Harvard Pilgrim and Tufts Health Plan will both be selling its own product portfolios for all 2021 effective dates. We will continue to keep you and your clients aware of any new changes or products during their renewal cycle.

In New Hampshire, will the combined organization offer both Harvard Pilgrim and Tufts Health Freedom Plan commercial products now?

No, only Harvard Pilgrim commercial products and plans will be offered to the market from this point forward by the combined organization. In connection with the combination, Tufts Health Freedom Plan was acquired by UnitedHealthcare Please see separate communications on this topic and visit the Tufts Health Freedom Plan website for further information.

In Connecticut, what is the relationship with Hartford Healthcare and CarePartners of Connecticut as it relates to this combination?

Tufts Health Plan and Hartford Healthcare are partners in a joint venture which offers Medicare Advantage plans (branded as CarePartners of Connecticut) to eligible adults in Connecticut. The Medicare product offerings in Connecticut will not change immediately as a result of this combination with Harvard Pilgrim.

Will the Tufts Health Plan or Harvard Pilgrim provider networks change?

In the near term, there are no changes to the Tufts Health Plan or Harvard Pilgrim provider networks. We are reviewing the provider networks with the intention of building the strongest networks for our members. We will notify you well in advance of any network changes.

Which national provider network will the new organization use?

We are currently evaluating our national provider networks and will be issuing a formal RFP in 2021. All products will maintain their current national network through 2022.

Will there be changes in pharmacy benefit managers (PBMs)?

We are currently evaluating our PBMs and will be issuing a formal RFP in 2021. All products will maintain their current PBM through 2022.

Will there be changes in the care management model?

Both Harvard Pilgrim and Tufts Health Plan will be leveraging their existing care management model for 2021. We are evaluating the most effective care management approach for the future.

Will there be changes to the behavioral health models or vendors?

Both Harvard Pilgrim and Tufts Health Plan will be leveraging their existing behavioral health model and vendor for 2021. We are evaluating the most effective behavioral health model for the future.

Will there be changes to ancillary partners?

There will be no changes for 2021. We are currently evaluating both Harvard Pilgrim's and Tufts Health Plan’s ancillary partners and will be issuing formal RFPs, if necessary, in 2021.

Will there be changes in wellness programs?

Both Harvard Pilgrim and Tufts Health Plan will leverage their existing wellness programs for 2021. We are evaluating our programs for 2022 and beyond.


Member Impact

Will there be any member impact at date of close?

No. Maintaining excellent customer service and experience is our top priority. Members will continue to access information and services through their existing member portal and contact each health plan via the same member services phone numbers they use today. Member ID cards will not change, and members will continue to access health care services, provider networks and benefits without interruption.


Broker Compensation

What will happen to my 2021 broker compensation program?

Each organization’s respective 2021 broker compensation program will remain in place throughout 2021.The combined organization will release its 2022 broker compensation program to the marketplace prior to Q4 2021.

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