Advantage HMO Select Information for Brokers
A Limited Provider Network Option
Tufts Health Plan’s Advantage HMO Select is a deductible plan that offers comprehensive coverage at a competitive price. Advantage HMO Select is easy to administer and use, with no claim forms to fill out—plus it is designed to deliver value for employers and plan members alike.
This plan provides access to a network that is smaller than Tufts Health Plan’s standard network. In this plan, members have access to network benefits only from providers in the Select Network, and must choose a primary care provider (PCP) from our Select Network to provide or arrange for their care.
The Advantage HMO Select plan features:
- A deductible that applies for inpatient hospital care, day surgery, outpatient diagnostic, emergency room, and certain other services. After a member meets the deductible, services subject to the deductible are covered in full.
- Preventive/routine services covered with no member cost sharing.
- Office visits and specialist consultations are covered with a copayment for each visit.
- Services to diagnose, treat, or monitor health conditions are subject to the deductible.
- Emergency and urgent care coverage anywhere in the world, 24 hours a day, seven days a week.
- Wellness and disease-management programs to help keep members healthy while controlling costs.
- Discounts on fitness club memberships, acupuncture, massage, and more.
How the Plan Works
Advantage HMO Select members select a PCP from our Select Network of providers to provide and coordinate his or her care. At each office visit, a member presents his or her ID card and pays the applicable copayment. Deductible and coinsurance may apply. Once members reach the out-of-pocket maximum, they are covered at 100%.
For care from a specialist, a member’s selected PCP will refer the member to a specialist within the Select Network. A member is required to obtain a referral in order to receive coverage for the specialist’s services.
After a member satisfies the deductible, he or she receives covered services with just a copayment, when applicable.
This plan provides access to a network that is smaller than Tufts Health Plan’s standard network. In this plan, members have access to network benefits only from the providers in the Select Network. Please consult the Select Network provider directory by visiting the provider search tool at tuftshealthplan.com and click on Find a Doctor to determine the providers in the Select Limited Provider Network. If you need a paper copy of the provider directory, please contact member services.
If a member's plan includes the optional pharmacy benefit, they will pay a copayment for each prescription, according to our three-tier pharmacy copayment program:
- Tier 1: Lowest copayment; includes most generic drugs
- Tier 2: Middle copayment; includes many brand-name drugs
- Tier 3: Highest copayment; includes the most costly covered brand-name drugs not included in other tiers.
Note: This a summary of the plan features. Please refer to the benefit document for a detailed explanation of coverage. If there is a difference between the information in this document and the benefit document, the terms of the benefit document will govern.
Superior Customer Service
Our Member Services department offers your employees a staff of highly trained professionals. One phone call is all it takes to reach our Member Specialists. They are available to answer members’ questions about the plan and their benefits. We also offer language-translation services and TTY capabilities as needed.
For more information, contact your sales office:
Watertown 800-208-8013 | Worcester 800-208-9545 | Providence 800-455-2012