Snapshot of Your Plan
 
 

Your Lifespan Premier Choice PPO Plan, at a Glance

Copay **Please see details below**
Coinsurance **Please see details below**
Out-of-Pocket Max Yes.
Health Savings Account (HSA) No.
Primary Care Physician (PCP) No. You are not required to select an in-network PCP.
Referrals No. Referrals are not required to see a specialist. 
Out-of-Network Coverage Yes.
Routine Vision Care Yes.

Important note: You will see the term “Benefit Document” throughout this Welcome Kit. Your Benefit Document is a legally binding document provided by us that explains your medical coverage, including covered benefits, exclusions, termination, continuation of coverage, and appeals. It is sometimes referred to as an Evidence of Coverage (EOC) document or a Certificate of Insurance (COI). If there is a difference between the information in this Welcome Kit and your Benefit Document, please rely on your Benefit Document.

You can find your Benefit Document in the My Coverage section of mytuftshealthplan.com.

Cost Sharing

Copayments

There are some services that may require a copayment with your plan. A copayment is the cost-share that you pay for certain covered pharmacy or medical services. Depending on your plan, you might have a copayment for a doctor’s office visit or for a prescription drug.

You can find your copayment amounts in 3 places:

  1. On the front of your ID card
  2. In the My Coverage section of mytuftshealthplan.com
  3. In your Benefit Document
Coinsurance

There are some services that may require coinsurance with your plan. Coinsurance is the percentage of costs you pay for certain covered services. As an example, if your plan has 20% coinsurance, Tufts Health Plan will pay 80% of the cost, and you’ll be responsible for paying 20% of
the cost.. It mainly applies to durable medical equipment (things like wheelchairs, crutches and hearing aids).

You can find out which services require coinsurance in 2 places:

  1. In the My Coverage section of mytuftshealthplan.com
  2. In your Benefit Document 

Login to mytuftshealthplan.com. Under My Coverage (1) you will find a complete list of your plan benefits. Select a benefit category to see your cost sharing responsibility (2) including copayments and coinsurance, if applicable.

Out-of-Pocket Max

The Out-of-Pocket maximum is the most you can pay during your plan year for your share of covered medical, pharmacy, vision and mental health services. After you spend this amount on deductibles, copayments, and coinsurance, Tufts Health Plan will pay 100% of remaining costs for covered services. However, your monthly premium does not count toward this total..

You can find the Out-of-Pocket Max for your plan in several places:

  1. In your Benefit Document
  2. In the Claims section of mytuftshealthplan.com, select the Out-of-Pocket Maximum tab

Login to mytuftshealthplan.com. Under Claims (1) select the Out-of-Pocket Maximum tab (2) to view how your costs have applied to your Individual and Family limits.

Getting Care

Visiting the Doctor

Your plan gives you the freedom to visit any health care provider you want. You may visit a Primary Care Provider (PCP), or you can visit a specialist. No referral is required.

When you choose a doctor, you should consider whether that doctor is in our network or not. Choosing an in-network doctor will result in the lowest out-of-pocket costs possible.

Check your Benefits Document in your member portal for more details on in-network and out-of-network costs. 

View your in-network provider directory.

Vision

You have access to EyeMed Vision Care, one of the nation’s leading vision care organizations. You can receive routine eye exams and other vision care services provided through EyeMed’s extensive network of providers, which includes many independent practices, as well as retail stores like LensCrafters, Sears Optical, Target Optical, JCPenney Optical and Pearle Vision (most locations).

Search for an EyeMed provider here.