Tufts Health Plan and Harvard Pilgrim Health Care Combination

Frequently Asked Questions (FAQ) for Employers

Last Updated January 4, 2021

We’ve developed these FAQs to help you answer questions your employees may have now that Tufts Health Plan and Harvard Pilgrim Health Care have combined into one company. We’ll update the questions and answers regularly as new information is available.

Basic Information

What health plan am I a member of?

You are a member of Tufts Health Plan which is currently listed on your member ID card. If you have questions about your current plan, you should continue to call the numbers listed on your ID card.

Can I use my current ID card, or will it change?

Please continue to use your existing member ID card and ID number.

If something does change, when and how will I be notified of change?

No changes to your plan and benefits are planned in the near-term due to Harvard Pilgrim and Tufts Health Plan coming together as one organization. As always, if anything changes, you will receive advance notice to help you understand the changes and how you may be affected. If you have specific questions, you should call the Member Services number printed on your ID card.

Who will I receive mail from?

You will continue to receive mail from Tufts Health Plan.

Which website do I log in to? Is my account information the same?

You should continue to log in to the Tufts Health Plan website you use today. Your account information remains the same.


Coverage and Benefits

Will my benefits change?

There are no current changes to your benefits related to Harvard Pilgrim and Tufts Health Plan coming together as one organization.

How does this affect my copayments and deductibles, and my deductible reset date?

There are no current changes to your copayments and deductibles due to the combination.

Will my pharmacy benefits change? Can I still fill my prescriptions where I do today?

There are no current changes to your pharmacy benefits or pharmacy network due to the combination.    

Will my prescription drug coverage remain the same? Do I still have access to the Tufts Health Plan prescription drug formulary?

There are no current changes to the prescription drug formulary you are using now due to the combination.  You can continue to access the formulary for the plan you’re currently enrolled in through Tufts Health Plan.

How does the combination of Tufts Health Plan and Harvard Pilgrim affect my health savings account HSA or FSA?

There are no current changes to your HSA or FSA due to the combination.

Will there be any changes to my wellness discounts, benefits or reimbursement programs?

You can continue to enjoy all programs and services that come with your plan today, which includes our health and wellness offerings, and reimbursement and discount programs.


Network of Providers and Hospitals

Will my PCP change?

You can continue seeing your current PCP. If your PCP leaves our provider network for reasons not related to the combination, you will, of course, need to find a new PCP.  We would notify you of those changes and help you find a new PCP. The same is true for specialists. Our network of specialists is not changing at this time as a result of the combination.

Will all my doctors know about any changes related to my plan?

Yes. Just as we are committed to providing clear and frequent communication to our members, we are also communicating with the providers in our network.

Will the provider network I use remain the same?

Yes, your provider network will remain the same throughout 2021. You should continue to access your Tufts Health Plan providers, based on your current health plan.

Is my service area changing? Will my referral circle change?

Currently nothing changes within your service area. You should continue to access your Tufts Health Plan providers, based on your current health plan.


Utilization Management

Will my authorizations and referrals still be good?

Currently nothing changes with authorizations or referrals.

What happens if I’m in the middle of treatment or an inpatient hospital stay as Tufts Health Plan and Harvard Pilgrim combine?

You can feel confident that your care will not be affected. Your insurance coverage will not change, and you can continue to see all the same providers who are involved in your care as long as they remain part of the network.


Care Management, Wellness and Behavioral Health

I’m currently enrolled in the care management or health coaching program through Tufts Health Plan. Can I continue to work with the same care manager?

Yes. For the time being, nothing will change with your care manager or health coach. It’s possible, however, that your care manager could change sometime in the future. If that happens, we are committed to giving you advance notice and will answer all your questions.

Can I continue to see my current behavioral health therapist?

Yes, you can continue seeing your current therapist. If he or she leaves our provider network for reasons not related to combination, you would need to find a new therapist. If this happens, we would notify you of the change and help you find a new therapist.


Payments and Reimbursements

Where should I send claims forms and reimbursement forms?

You should continue to send your forms to your current health plan. The appropriate addresses are listed on the forms. To find a form, go to tuftshealthplan.com.

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