2022 Benefit Documents

• HMO Basic Platinum
• Advantage HMO 500
• Advantage HMO 1000
• Advantage HMO 1500
• Advantage HMO 1500 (90%)
• Advantage HMO Basic 2000
• Advantage HMO 2000
• Advantage HMO 2000 (80%)
• Advantage HMO 2500
• Advantage HMO 3000
• Advantage HMO 4000
• Advantage HMO 5000
• Premier HMO Gold
• Premier HMO Platinum
• Premier HMO Silver 2000
• Premier HMO Gold 2000
• Advantage HMO Saver 2000
• Premier HMO Saver Silver 2000
• Advantage HMO Saver 2500
• Premier HMO Bronze Saver 3200
• Advantage HMO Saver 3000
• Advantage HMO Saver 3600

• Advantage PPO 500
• Advantage PPO 1000
• Advantage PPO 1500
• Advantage PPO 2000
• Advantage PPO 3000
• Advantage PPO 4000
• Advantage PPO Saver 2000
• Advantage PPO Saver 3000
• Advantage PPO Saver 5000
• Premier PPO Silver Saver 3000

• Select Advantage HMO 1000
• Select Advantage HMO 1500
• Select Advantage HMO 2000
• Select Advantage HMO 2500
• Select Advantage HMO 3000

• Your Choice HMO 1500
• Your Choice HMO 3000
• Your Choice HMO Copay (65%)

• Premier HMO Gold
• Premier HMO Platinum
• Premier HMO Silver 2000
• Premier HMO Gold 2000
• Premier HMO Saver Silver 2000
• Premier HMO Bronze Saver 3200
• Premier PPO Silver Saver 3000

• Tufts Medicare Complement Plan - Rx package 8/20/35
• Tufts Medicare Complement Plan - Rx package 10/25/50
• Tufts Medicare Complement Plan - Rx package 10/30/65
• Tufts Medicare Complement Plan - No Rx

• Advantage HMO 500
• Advantage HMO 750
• Advantage HMO 1000
• Advantage HMO 1500
• Advantage HMO 2000
• Advantage HMO 2000 (80%)
• Advantage HMO 2500
• Advantage HMO 3000
• Advantage HMO 4000
• Advantage HMO 4000 (80%)
• Advantage HMO 5000
• Advantage HMO 6000
• Advantage HMO Saver 2500
• Advantage HMO Saver 3000
• Advantage HMO Saver 4000
• Advantage HMO Saver 6900
• HEALTHpact Advantage
• HEALTHpact Basic

For plans effective on or after July 1, 2022, the Doula Services benefit has been updated.

• Advantage HMO 500
• Advantage HMO 750
• Advantage HMO 1000
• Advantage HMO 1500
• Advantage HMO 2000
• Advantage HMO 2000 (80%)
• Advantage HMO 2500
• Advantage HMO 3000
• Advantage HMO 4000
• Advantage HMO 4000 (80%)
• Advantage HMO 5000
• Advantage HMO 6000
• Advantage HMO Saver 2500
• Advantage HMO Saver 3000
• Advantage HMO Saver 4000
• Advantage HMO Saver 6900
• HEALTHpact Advantage
• HEALTHpact Basic

• Advantage PPO 500
• Advantage PPO 750
• Advantage PPO 1000
• Advantage PPO 1500
• Advantage PPO 2000
• Advantage PPO 2000 (80%)
• Advantage PPO 2500
• Advantage PPO 3000
• Advantage PPO 4000
• Advantage PPO 4000 (80%)
• Advantage PPO 5000
• Advantage PPO 6000
• Advantage PPO Saver 2500
• Advantage PPO Saver 3000
• Advantage PPO Saver 4000
• Advantage PPO Saver 6900

For plans effective on or after July 1, 2022, the Doula Services benefit has been updated.

• Advantage PPO 500
• Advantage PPO 750
• Advantage PPO 1000
• Advantage PPO 1500
• Advantage PPO 2000
• Advantage PPO 2000 (80%)
• Advantage PPO 2500
• Advantage PPO 3000
• Advantage PPO 4000
• Advantage PPO 4000 (80%)
• Advantage PPO 5000
• Advantage PPO 6000
• Advantage PPO Saver 2500
• Advantage PPO Saver 3000
• Advantage PPO Saver 4000
• Advantage PPO Saver 6900

• Lifespan Premier Choice HMO 750
• Lifespan Premier Choice HMO 1000
• Lifespan Premier Choice HMO 1500
• Lifespan Premier Choice HMO 2000
• Lifespan Premier Choice HMO Copay (55%)
• Lifespan Premier Choice PPO 750
• Lifespan Premier Choice PPO 1000
• Lifespan Premier Choice PPO 1500
• Lifespan Premier Choice PPO 2000

For plans effective on or after July 1, 2022, the Doula Services benefit has been updated.

• Lifespan Premier Choice HMO 750
• Lifespan Premier Choice HMO 1000
• Lifespan Premier Choice HMO 1500
• Lifespan Premier Choice HMO 2000
• Lifespan Premier Choice HMO Copay (55%)
• Lifespan Premier Choice PPO 750
• Lifespan Premier Choice PPO 1000
• Lifespan Premier Choice PPO 1500
• Lifespan Premier Choice PPO 2000