Understanding Our Network
 
 

Two Tiers. Premier Quality.

Lifespan Premier Choice opens up possibilities for you with two levels of in-network care. You pay different levels of copayments, coinsurance, and/or deductible for covered services delivered by Tier 1 and Tier 2 providers.On the Lifespan Premier Choice PPO plan, you also have the option to see providers outside of the Tufts Health Plan network. If you choose to use out-of-network benefits, you will have the highest cost share.

Lifespan Premier Choice offers high-value benefits and access to premier quality care through the Lifespan health system, made up of more than 1,800 doctors and providers, on Tier 1. You have access to the entire Tufts Health Plan network on Tier 2, but have higher costs. So, you are covered to see any provider, but staying within the Lifespan health system provides you top quality at a lower cost.

Maternity and Newborn Services

When received within the Tufts Health Plan network, maternity and newborn services are covered at the Tier 1 level, regardless of which hospital you choose. This includes routine and non-routine pregnancy and deliveries, diagnostic imaging, and inpatient newborn services.

Behavioral Health Services and Treatments

For plans that include behavioral health services and treatments, these services are also covered at the Tier 1 level when you receive authorization, and you can access any facility in or outside of the Tufts Health Plan network. We have comprehensive programs and a network of professionals ready to help behavioral health issues such as autism, substance use disorders, psychological and/ or neurological issues.

Choosing Your Tier

Top quality access to Lifespan doctors, hospitals, and facilities are all in Tier 1. However, if the doctor or hospital you really want is in the wider Tufts Health Plan network, you have the freedom to choose him or her, or to receive covered services outside of the Tufts Health Plan network, but you’ll pay higher out-of-pocket costs.

Can I Mix and Match Tiers?

Yes. So let’s say your PCP is part of Lifespan and you need knee surgery. Your doctor will most likely refer you to a Lifespan specialist and hospital. But let’s say you’re interested in a Tufts Health Plan network specialist (Tier 2). If so, you can choose that doctor, but your out-of-pocket costs will be higher.

Another scenario might be that you have a long relationship with your family doctor, but they are not part of Lifespan. You prefer to continue seeing that doctor, knowing your out-of-pocket costs will be higher. But your spouse doesn’t really mind seeing another doctor, and decides that they want to stay within the Lifespan system. In this scenario, it’s perfectly okay to mix and match, and give everyone their choice.

Lifespan Hospitals

Lifespan hospitals offer the lowest out-of-pocket costs on this plan. Lifespan hospitals are Tier 1 and offer a robust selection of more than 1,800 PCPs and specialists. All other hospitals in the Tufts Health Plan network are Tier 2.

Emergency Care

In a serious emergency situation, though, you don’t have to think about this. You just call 9-1-1 if the situation warrants it, or drive to the nearest emergency room if that’s appropriate. Under the Lifespan Premier Choice PPO plan, the emergency room copay is always equal to the Tier 1 emergency room copay for both the doctor and the hospital, in or outside of the Tufts Health Plan network.