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Many of these resources have recently moved to our provider website on point32health.org.

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We want to make it easy for you to work with us, so we’ve brought the training information for Point32Health’s legacy brands — Tufts Health Plan and Harvard Pilgrim Health Care — together in one spot.

Training

We’ve brought provider news information for Point32Health’s legacy brands — Tufts Health Plan and Harvard Pilgrim Health Care — together in one spot. Visit our news resources on point32health.org/provider

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Below are overviews of Tufts Health Plan’s offerings, which include benefit information, authorization requirements, overviews of specific plans and coverage information.

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Employer Forms + Documents

1043634089-2019 Additional MLR Rebates - Employer FAQs-020123

Small Employer Group and Individual Benefit Documents

2023 Small Group EOCs

3rd Party Admins HRA HSA

Benefit Enrollment and Maintenance Transaction

834 5010 Standard Companion Guide

A summary of highlights of new regulations

ACA - Employer Shared Responsibility Provision

Includes a summary of ACA fees, who pays, what the fee is used for, fee amount, and when payment begins

ACA Fees—Information for Employer Groups

Use this form to account for all employees and their dependents

Account Census Form

2023 Summary of Benefits + Coverage - Rhode Island

Advantage HMO 1000

Advantage HMO 1500

Advantage HMO 2000

Advantage HMO 2000 (80%)

Advantage HMO 3000

Advantage HMO 4000 (70%)

Advantage HMO 500

Advantage HMO 5000

Advantage HMO 6000

Advantage HMO Saver 2500

Advantage HMO Saver 3000

Advantage HMO Saver 6000

Advantage PPO 1000

Advantage PPO 1500

Advantage PPO 2000

Advantage PPO 2000 (80%)

Advantage PPO 3000

Advantage PPO 4000 (70%)

Advantage PPO 500

Advantage PPO 5000

Advantage PPO 6000

Advantage PPO Saver 2500

Advantage PPO Saver 3000

Advantage PPO Saver 6000

Behavioral Health Executive Summary

Behavioral Health Facilities

Behavioral Health Resource Guide

Broker Portal Authorization Form

BrokerLink Change Access Administrator Form

Use this form to designate a new Senior Access Administrator for your Tufts Health Plan website account

Change Senior Access Administrator Form

COB Prescription Co-Pay Reimbursement Form - USFHP

Coordinated Care Model Brochure

Daily Endorphin Brochure

Deductible Carryover - Calendar Year

Deductible Carryover - Plan Year

Disabled Dependent Evaluation Form

This notice is sent to notify an employee that their continuation coverage has terminated or will terminate

Early Termination Notice

EDI Enrollment + Reconciliation Guide

Frequently asked questions with answers about Massachusetts Continuation of Coverage

Employer Group Overview of MA Continuation of Coverage

This form must be completed by an employer group to identify a third-party representative/vendor that is permitted to receive information on their behalf.

Employer Group Vendor Designation Form

Authorization/request for electronic access to information submitted to Tufts Health Plan

Employer Web Authorization Form

Federal MLR FAQs

Includes informative flyer, postcard, and table tent

Flu Kit for Members

Includes Announcement, Reminder, and Final Reminder for on-site flu shots

Flu Shot Email Campaign

To be completed by brokers and employers that are new to Tufts Health Plan

Form W-9 (IRS)

Complete this form to initiate a health promotion request.

Health Promotion Request Form

HEALTHpact Advantage

HEALTHpact Basic

Description of requirements for your employees to qualify for Advantage Level HEALTHPact benefits.

HEALTHPact Employer Instruction Guide

Instructions on how to comply with HIPAA requirements to receive PHI in order to perform certain functions on behalf of your employer group clients

HIPAA Instructions for Brokers and Employer Group Vendors

Large Group Census Template

Use this list of items to enroll your group in Tufts Health Plan

Large Group Enrollment Checklist

Lifespan Premier Choice HMO 1000

Lifespan Premier Choice HMO 2000

Lifespan Premier Choice HMO Copay (55%)

Lifespan Premier Choice PPO 1000

Lifespan Premier Choice PPO 2000

This form provides Tufts Health Plan with documentation that you will not pair an HRA with this plan

Lifespan without HRA Attestation

MA Broker Agency Application

This notice contains important information about your employee's right to continue your health care coverage under the group health plan

MA Continuation of Coverage Election Form

This notice contains important information about your employee's right to Massachusetts Continuation of Coverage

MA Continuation of Coverage Rights Notice

MA Employer Group EPO Self-insured Manual

MA Employer Group HMO Manual

MA Employer Group POS Fully-insured Manual

MA Employer Group POS Self-insured Manual

MA Employer Group PPO Fully-insured Manual

MA Employer Group PPO Self-insured Manual

MA Individual Broker Application

Massachusetts large group employer application

MA Large Group Application

MA Large Group Quote Request Form

MA Large Group Underwriting Guidelines for New Business

MA Large Group Underwriting Guidelines for Renewals

Massachusetts small group employer application

MA Small Group Application

This document is provided to Tufts Health Plan when a WR-1 form is not required to be filed, and if your company is either a start-up, C Corp, sole proprietorship, or partnership

MA Small Group Attestation

Submit the items in this list to help set up your Tufts Health Plan coverage

MA Small Group Employer Welcome Kit

Forms & documents

Essential resources for employers

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