Frequently Asked Questions
Answers to some common questions we receive from our members when they join Tufts Health Plan
When will I receive my ID card?
You will receive your ID card before or within 7-10 business days of your effective date. You may also view or print your ID card from your secure account at mytuftshealthplan.com or from our mobile app.
Where can I find my plan name?
You can find your plan name on your Summary of Benefits Coverage (SBC) and on your ID Card, when you recieve it. If you are unsure of your plan name, ask your employer.
Learn More About Our Plans
Where can I view my benefits/coverage?
Prior to being an active member, you will receive a Summary of Benefits Coverage (SBC) from your employer. This will outline many of your plans benefits. Once you are an active member, upon your effective date, your benefits begin. You can see your benefits on the member portal or the mobile app.
If you are unsure of your effective date, check with your employer.
Where do I call for behavioral health services?1
Please call to notify the Tufts Health Plan Behavioral Health Department at 800.208.9565. We are available Monday, Tuesday, Wednesday, and Friday from 8:30 a.m. - 5:00 p.m., and Thursday from 9:00 a.m. - 5:00 p.m.
Understanding Your Behavioral Health Benefits
How do I check my prescriptions and coverage?1
We have a prescription formulary, which is a list of drugs that is rated by use and costs. Most prescription drugs are in our formulary and are covered on a tiered level. Tier 1 has the lowest co-pay with Tiers 3 and 4 having the highest co-pay. Depending on your plan, you will have either a 3-tier or a 4-tier formulary.
Look Up Your Medication
Is my doctor in your network?
Chances are good that your doctor is in our network, which has more than 51,000 health care professionals and 100 hospitals across New England. Our network stretches across all of Massachusetts, Rhode Island and New Hampshire, and extends into parts of Maine, Vermont, Connecticut and New York. You can use our provider search at any time or log into mytuftshealthplan.com once you’re effective.
What is a referral and when do I need one?
A referral is permission from your primary care provider (PCP) to see a specialist for care. Certain plans, such as HMO and EPO plans, require you to get a referral. For POS plans, referrals are required for coverage at the in-network level of benefits. If you’re uncertain about whether or not you need a referral, call the Member Services number on your member ID card.
If your plan requires a referral, talk to your PCP. Always make sure that you have the referral before you see the specialist or you will be responsible for costs from the appointment.
Do I need to get new referrals when changing plans?
Any referral you had with your previous insurance plan will not carry over. If your plan requires a referral, you’ll need to get a new referral from your PCP. Also, if you see any other providers for care, be sure to let them know that you have new health insurance. If one of your current providers is not in our network, you will need to switch to one who is or you will be responsible for the full cost of services.
What is prior authorization and how do I get it?
Prior authorization means that we must approve a certain procedure or service before you receive it. Your provider submits a request to us, and we review it to be sure your care is following the most recent and successfully proven medical treatments. We check to make sure you receive the appropriate level of care, at the appropriate time, in the right setting, and in the most efficient manner.
Your in-network doctor is responsible for obtaining prior authorization from us on your behalf. If your plan allows for out-of-network services, you are responsible for making sure your provider obtains prior authorization.
What do I do if I'm scheduled for upcoming services?
Contact your provider’s office and let them know you have switched plans. Talk to them about obtaining any necessary referrals and/or authorizations.
How do I get access to a doctor when I'm traveling?
If you have an unforeseen or emergency medical condition, seek care immediately at the nearest medical facility. You are not required to see an in-network provider for emergency medical care when traveling outside of the service area. However, you will need to receive any necessary follow-up care at an in-network provider or you will be responsible for the cost of the follow-up services.