Know your care options

Getting the care you need, at the right time, in the right setting

Health care isn’t one-size-fits-all. At Tufts Health Plan, we offer many ways for you to get the care you need, where and when it’s convenient for you. This quick guide helps you select the right care for your specific needs, day or night, virtually or in-person.1

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Knowing your care options ahead of time can save you time and money

When you’re sick or injured, the last thing you want to worry about is where to go. The emergency room is the best option for care when a life-threatening illness or injury occurs, but when it’s not a life-threatening condition, visiting the emergency room can be time consuming and expensive.

Going to the emergency room for non life-threatening emergencies, on average, could cost over $2,000 — that's 12 times higher than a PCP visit and 10 times higher than an urgent care visit.2

Quality care that’s right for you and meets your needs

From minor cuts to a sore throat or even a blood pressure check, knowing where to seek care for your situation can save you time and money. As a Tufts Health Plan member you and your dependents have access to a variety of options:

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When you experience chest pain, difficulty breathing, suffer a broken bone, or you feel your life is in danger, should always call 911 or go to the nearest emergency room.

For non-urgent needs such as preventive screenings, checkups, immunizations, or ongoing conditions, your PCP knows your medical history and coordinates your care. Plus, your provider may also offer virtual health care services. If you seek care outside of your PCP's office, please request that the provider share documentation with your PCP to better manage your care. Don’t have a PCP? Visit our provider search tool to search for PCPs near you.

You can stop by an urgent care center and be seen immediately without an appointment during evenings and weekends, for conditions that need to immediate treatment but are not considered life-threatening. Examples include minor burns or cuts that may require stitches. Visit our provider search tool to find an urgent center care near you.

Retail clinics such as CVS MinuteClinic® and Walgreens Healthcare Clinic are a good option when you’re experiencing mild symptoms such as an ear infection or skin conditions like poison ivy, and you want a health professional to check it out without an appointment. Find a location near you at cvs.com/minuteclinic or walgreens.com.

If you have a chronic condition, such as diabetes, heart disease, respiratory disease, or questions related to pregnancy and behavioral health, you can speak with a dedicated nurse care manager, who can provide support and help coordinate your care at no cost. Our Care Team of registered nurses, clinical social workers and certified health coaches will answer your questions, help you navigate the health care system and support your health and wellness goals by phone email our mobile app. Login to your secure account or call 888-766-9818 extension 53532 to learn more.

Teladoc U.S.-based doctors are available 24/7 at no cost3 for most plans by phone or mobile app.  You can request a virtual visit with a U.S.-based doctor 24/7 for conditions such as upper respiratory infection, upset stomach or connect with a dermatologist for a common skin condition. You can also access confidential therapy and build an ongoing relationship with the provider of your choice; appointments are confirmed in less than 48 hours.

With your PPO plan, if you live outside of New England or have children attending school across the country, our national coverage extends from coast-to-coast providing you with better, seamless access to our New England network of doctors coupled with the Cigna PPO4 network.

  • More than 1M providers and 6,300 hospitals
  • More easily accessible, affordable, and high-quality care
  • Visit our provider search tool to see which care options are in your network. By getting care from providers and facilities that are in your network, you’ll save money and avoid unexpected bills

 

  1. This guide is for educational purposes only and does not constitute medical advice. Always seek the advice of a qualified health care provider. Cost share may apply, please refer to your plan documents for your specific benefit information.
  2. 2016 study in the Annals of Emergency Medicine.
  3. Telehealth virtual health care services (provided by Teladoc®) are available to Tufts Health Plan commercial members (not including Tufts Health Direct) and self-insured groups that have selected this benefit. There will be no cost share or copay for Teladoc services to employer-sponsored groups that have this benefit and have not opted out; cost share may apply to some self-insured groups. Cost share will apply to Saver plan members starting 1/1/2022. If you’re not sure whether your plan includes Telehealth by Teladoc please ask your employer.
  4. The Cigna PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna PPO Network for Shared Administration. Cigna is an independent company and not affiliated with Tufts Health Plan. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company.