HMO Select Plan Overview
A Limited Provider Network Option
Our HMO Select plan is a high-quality managed care plan that is simple to administer. There are no claim forms to fill out—most services are covered with just a copayment.
This plan provides access to a network that is smaller than Tufts Health Plan’s standard network. In this plan, members have access to network benefits only from providers in the Select Network, and must choose a primary care provider (PCP) from our Select Network to provide or arrange for their care. Please consult the Select Network provider directory by visiting the provider search tool at tuftshealthplan.com and click on Find a Doctor to determine the providers in the Select Limited Provider Network. If you need a paper copy of the provider directory, please contact member services.
The HMO Select plan features:
- Emergency and urgent care coverage anywhere in the world, 24 hours a day, seven days a week.
- Comprehensive disease management and wellness programs at no extra charge.
- Discounts on fitness club memberships, acupuncture, massage, and more.
How the Plan Works
HMO Select members must choose a PCP from the Select Network. The PCP must provide or authorize all of the member’s care. Then, the member presents his or her ID card at each office visit, and pays the applicable copayment.
For specialist care, the PCP must refer the member to a specialist within the Select Network. A member is required to obtain a referral in order to receive coverage for the specialist’s services.
If your plan includes the optional pharmacy benefit, members will pay a copayment for each prescription, according to our three-tier pharmacy copayment program:
- Tier 1: Lowest copayment; includes most generic drugs
- Tier 2: Middle copayment; includes many brand-name drugs
- Tier 3: Highest copayment; includes the most costly covered brand-name drugs not included in other tiers.
Note: This a summary of the plan features. Please refer to the benefit document for a detailed explanation of coverage. If there is a difference between the information in this document and the benefit document, the terms of the benefit document will govern.
Superior Customer Service
Our Member Services department boasts a staff of highly-trained, professionals. One phone call is all it takes to reach our Member Specialists. They are available to answer members’ questions about the plan and their benefits. We also offer language translation services and TTY capabilities as needed.
For more information, contact your sales office:
Watertown 800-208-8013 | Worcester 800-208-9545 | Providence 800-455-2012