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

Policies & coverage

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

News

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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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This benefit applies to most Massachusetts and Rhode Island (large group) plans and is available upon renewal in 2023.&nbsp;

2023 Fitness Rebate Form

Effective January 1, 2023 - Members can check this full list of low-cost generic drugs to see if they can save on their medications

2023 Low-Cost Generic Drug Program

For members on a Saver plan. List is subject to change.

2023 Preventive Drug List: Saver Groups

This benefit applies to most Massachusetts (large group) and Rhode Island (large and small group) plans and is available upon renewal in 2024.

2024 Fitness Rebate Form

Effective January 1, 2024 - Members can check this full list of low-cost generic drugs to see if they can save on their medications

2024 Low-Cost Generic Drug Program

2024 Preventive Drug List: Saver Groups

Roll over your deductible to the next year and save!

4th Quarter Deductible

Acupuncture

ADHD Brochure

ADHD Brochure - Spanish 

Alcohol + Substance Use Brochure

Alcohol + Substance Use Brochure - Spanish 

Attention-Deficit/Hyperactivity (ADHD) Symptom Checklist

Use this form to authorize Tufts Health Plan* to use or disclose your protected health information.

Authorization to Disclose Protected Health Information

Use this form to authorize USFHP* to use or disclose your protected health information.

Authorization to Disclose Protected Health Information - USFHP

Autism Brochure

Autism spectrum disorders include autism, pervasive developmental disorder, and Asperger’s syndrome. Autism spectrum disorders are brain disorders in which a child shows varying degrees of deficiency in social interactions, verbal and nonverbal communicat

Autism Spectrum Disorders - Behavioral Health Brochure

A list of Behavioral Health Facilities in Massachusetts, Rhode Island, and New Hampshire. Organized by state and service provided.

Behavioral Health Facility Listing by Service

A list of Behavioral Health Facilities in Massachusetts, Rhode Island, and New Hampshire. Organized by state.

Behavioral Health Facility Listing by State

All Facilities - Massachusetts, New Hampshire, and Rhode Island

Behavioral Health Participating Facilities

Inpatient, Acute Residential Treatment, Partial Hospital and Intensive Outpatient Programs by Age and Diagnostic Category

Behavioral Health Services for Children & Adolescents (BHCA) Provider Directory

Providing Compassionate Support Each Step of the Way&nbsp;

Care Management Brochure

CareLink Case Management Brochure

Case Management Brochure - Spanish

Tufts Health Plan Community Behavioral Health Center (CBHC) network

CBHC Commercial Directory

This form may be used by an individual to certify to Tufts Health Plan&nbsp;that they are the parent of a member when they are not enrolled on the same policy.

Certification of Parental Rights

This form may be used by an individual to certify to USFHP that they are the parent of a member when they are not enrolled on the same policy.

Certification of Parental Rights - USFHP

Chronic Obstructive Pulmonary Disease (COPD) Brochure

COB Prescription Co-Pay Reimbursement Form - USFHP

Cobra Questionnaire

Massachusetts Fully-Insured Plans Only

Commercial Summary of Payments FAQ

As required by HIPAA and state law, including but not limited to R.I.G.L. c. 5-37.12 ("Confidentiality of Health Care Communications and Information Act"), you may use this form to request confidential communications containing your health information by an alternate means or at an alternate location (different than the Policy holder address).

Confidential Communications Request Form

Congestive Heart Failure Brochure

Coordinated Care Model Brochure

Coronary Artery Disease Brochure

Depression Brochure

Depression Brochure - Spanish

This form may be used to designate a representative to act on a member’s behalf and authorize Tufts Health Plan&nbsp;to disclose the member’s protected health information to the representative.

Designated Representative Form

This form may be used to designate a representative to act on a member’s behalf and authorize USFHP&nbsp;to disclose the member’s protected health information to the representative.

Designated Representative Form - USFHP

Diabetes

Diabetes Brochure

Disabled Dependent Evaluation Form

Eating Disorders Brochure

The following questionnaire was developed to detect if a woman may have depression following childbirth. Please save this questionnaire and answer the questions six to eight weeks after your delivery.

Edinburgh Postnatal Depression Scale (EPDS)

Enfermedad de las arterias coronarias

Enfermedad pulmonar obstructiva crónica (EPOC)

ExtraCare Health Program 

Fraud, Waste, and Abuse Hotline 

Glossary of Health Coverage and Medical Terms

Home Health Agencies with Lactation Counseling Services

Your EOB is a statement that shows what health services you received, what bills your health plan paid, and what you may still owe to a health care provider.

How to Read Your Explanation of Benefits (EOB)

IEPs and Requests for Authorization of Services

Insuficiencia cardíaca

MA Verification of Alternative Coverage

MA Verification of Alternative Coverage - Spanish

Use this Optum Rx form to order a new mail service prescription by fax from the prescribing physician’s office. Member completes section 1, while the physician completes sections 2 and 3.

Mail Service Prescription Physician Fax Order Form

Medical / Prescription Claims Profile Request Form

Medical / Prescription Claims Profile Request Form - USFHP

Use this form from the Massachusetts Coalition for the Prevention of Medical Errors to keep track of important health information and current medications

Medication List

Member Application

Member Discounts - PORT

Member Discounts - SPA

A brief guide to your health care coverage

Member Handbook

Member Non-Formulary Pharmacy Request Form

Member Reimbursement Medical Claim Form

Member Reimbursement Medical Claim Form - Spanish

Member Reimbursement Medical Claim Form - USFHP

Massachusetts, New Hampshire, and Rhode Island

Methadone Clinics

Illnesses and injuries come unexpectedly, and we all know it’s important to get care as soon as possible. MinuteClinic walk-in clinics at CVS Pharmacy® locations in Massachusetts are part of our provider network.

Minute Clinics

My Tufts Health Plan Brochure

Nondiscrimination - USFHP

Notice of Privacy Practices

Complete this form if you are visiting a provider that is not a participating provider in the EyeMed network

Out-of-network Vision Services Claim Form

If you are the Personal Representative of a member, please complete and submit this form with your legal documentation in order to be documented in Tufts Health Plan’s system.

Personal Representative Cover Form

If you are the Personal Representative of a member, please complete and submit this form with your legal documentation in order to be documented in the system.

Personal Representative Cover Form - USFHP

Pharmacy Brochure

Pharmacy Brochure - SPA

Lists of covered drugs for members with employer, individual or family plans (commercial plans)

Pharmacy Formularies

Preferred Drug List

This prenatal guide is your handy reference to the coverage, assistance and suggestions Tufts Health Plan provides during and immediately after your pregnancy. Plus, it is designed to guide you through some of the ups and downs of pregnancy and addresses

Prenatal Care - A Woman's Guide

Fill out this questionnaire, discuss it with your health care provider, and return it to our Health Programs Department, so that we may help to identify and support your pregnancy and health care needs.

Prenatal Questionnaire

Forms & documents

Employer, individual and family plans

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