Your benefits and costs 

To quickly see what’s covered under your plan and your copayments and out-of-pocket costs, take a look at our Benefits and Costs. We explain important terms, like deductible and coinsurance, in the “Cost-sharing Made Clear” section. 

Your member handbook 

Your handbook includes more details about your plan coverage, benefits, and rights and responsibilities. View or download the Member Handbook. 

To get a printed copy of your Member Handbook, including alternative formats such as large print or braille, call us at 888-257-1985 (TTY: 711). We can also give you information in other formats and different languages. We have bilingual staff available, and we offer translation services in more than 200 languages. All translation services are free to members. To request materials in other formats or languages, call us at 888-257-1985 (TTY: 711). 

Your member ID cards 

When you join Tufts Health Direct, you will get a member ID card in the mail about 10 days after your effective date. Each member of your family will receive a unique member ID card. If any information on your card(s) is wrong, please call member services at 888-257-1985 (TTY: 711). 

See which prescription drugs are covered 

Prescription drugs are covered when ordered by your physician/provider. Some brand-name drugs require prior authorization or may not be covered. For a complete, up-to-date list of which drugs are covered, and what to do if a drug you need isn’t covered, click here or call us at 888-257-1985 (TTY: 711).

Talk to a nurse any time

Call our 24/7 NurseLine any time at 888-MY-RN-LINE (888-697-6546) if you:

• Need help deciding whether or not you should go to the emergency room. 
• Want information about your condition and/or treatment options. 
• Have questions about medications or procedures. 

This service does not replace your primary care provider (PCP) or other providers. 

Care during regular office hours 

Call your PCP or specialist to schedule an appointment during regular business hours. To find a PCP or specialist in our network, use our Find a Doctor, Hospital or Pharmacy tool. 

Care after hours 

Call your PCP’s office for instructions if you need care after hours. Or visit a MinuteClinic walk-in clinic found in some CVS stores. Visit minuteclinic.com to find a site near you. 

You need your Tufts Health Direct member ID card when you visit your providers or pick up medications at the pharmacy. 

Urgent care 

Call your PCP or behavioral health provider in an urgent situation that is not an emergency or go to an in-network urgent care center. 

Emergency care 

Call 911 or go to the nearest emergency room right away if you need emergency care for: 

• Chest pain 
• Uncontrolled bleeding 
• A mental health or substance use crisis 

These examples are not a complete list of when you should seek emergency care. 

Get care in your own language 

Our Provider Directory shows if a provider speaks other languages in addition to English.

Fitness center reimbursement

Get back up to three months of fitness center membership fees for staying active! After you’ve been a Tufts Health Direct member for four consecutive months, you can apply for a reimbursement using the Fitness Center Reimbursement form. For more discounts and perks click here.

Good Measures

Manage your weight and create a healthy diet with the help of a dietitian through our Good Measures program. To learn more, go visit Good Measures or call 844-398-9510. 

Health coaching

Tap into a new source of motivation with a lifestyle program called Omada that offers support from peers, a health coach and more. To learn more, visit omadahealth.com or call 888-409-8687.

Care management

Care management is our way of making sure you get the support you need no matter what. Our care managers can help you:

• Manage symptoms and feel your best with conditions like asthma and diabetes
• Deal with long-term medical needs like cancer, caring for a sick newborn
• Get behavioral health care for things like depression or substance use issues

To get personal help from the Tufts Health Plan team, call 888-257-1985 (TTY: 711).

Behavioral health 

Behavioral Health Service Navigation is a cornerstone of Tufts Health Plan’s whole-person care approach. Our highly trained and dedicated team is ready to guide you from the very first phone call, to help ensure a compassionate and streamlined experience for you and your covered family members.

For more information, call Member Services at 888-257-1985 (TTY: 711).

Ovia

Ovia Health has maternity and family health solutions that can guide you through some of life's biggest transitions. Ovia offers support for reproductive health, starting a family, having a healthy pregnancy, balancing life as a working parent and managing menopause.

Ovia provides access to enhanced, personalized health and wellness content and in-app messaging.

To stay up to date on Ovia Health’s new features, sign up for Ovia  at the Apple Store or Google Play, or learn more here.

Eligible Tufts Health Direct members can get these great EXTRAS:

• A $50 or $25 gift card to use for a convertible or booster car seat.
• A supermarket gift card for adults who have a yearly checkup.
• A gift card for completing five routine diabetes screenings.

Click here for up-to-date information about EXTRAS, including eligibility. You can also download the EXTRAS form(s). To request EXTRAS, follow the directions on the form and send us the completed form. Note: EXTRAS are subject to change.

Member services 

You can reach our member services team at 888-257-1985 (TTY: 711), Monday through Friday, from 8 a.m. to 5 p.m., excluding holidays. Our team can help you: 

• Understand your benefits and medical bills 
• Find a provider or urgent care clinic 
• Get new a member ID card if you lose yours 

… and more. 

We have bilingual staff available and can provide translation if your first language is not English. 

Member portal 

Our member portal is an easy, convenient way to find the information you need, 24/7! Search for a provider or pharmacy, change your PCP, view your member ID card and more. Register here. 

Website 

Our website is another great way to find the information you need. Click here to view your plan details and find helpful tools: 

• Find a provider or pharmacy 
• Search for a drug on the Preferred Drug List 
• Get benefit details 
• View or download a Member Handbook