Did you receive an unexpected bill?
If you have questions about an unexpected bill or if you need to seek health care services from an out-of-network provider, please call the Member Services number on your member ID card.
Tools & resources
Helpful resources to keep you healthy
We’re on a mission to help our members stay healthy. But life gets busy and we know it’s not easy to make healthy lifestyle choices every day. Use the tools and resources here to manage your health so you can live a longer, healthier life. And of course, be sure to talk about all of your health care concerns with your doctor.
Medical necessity guidelines
Medical necessity guidelines are developed to determine coverage for benefits, and are published to provide a better understanding of how coverage decisions are made. We make coverage decisions using these guidelines, along with the Member’s benefit document, and in coordination with the Member’s physician(s) on a case-by-case basis considering the individual Member's health care needs.
In certain areas and for certain services, Tufts Health Plan delegates utilization management. In these situations, delegated vendor guidelines may be used to support medical necessity and other coverage determinations. If you have access to the Cigna PPO network and plan to seek services from a Cigna provider outside of MA/RI/NH then you may be subject to the Cigna medical necessity guidelines accessible below.
Online health library
We’ve designed this library of disease and condition content to help you make better health decisions. You can browse health information, check your symptoms and use the decision tools to better understand health procedures, medical tests, and health issues.
- Healthwise Health Library | Biblioteca de salud en línea
- Medline Plus health check tools and calculators
Healthy + Informed member newsletter
Our quarterly member newsletter features current wellness topics and benefit highlights. View our current edition.
Protection against domestic violence
If you or a family member are in immediate danger, call 911 at once.
The following resources will help you learn more about domestic violence, including identifying the warning signs, domestic violence laws, and what to do if you or a loved one have been affected:
- Massachusetts Coalition Against Sexual Assault and Domestic Violence (Jane Doe, Inc)
- Casa Myrna Vazquez
- New Hampshire Coalition Against Domestic Violence
- Rhode Island Coalition Against Domestic Violence
Children and adults with special needs
Tufts Health Plan provides benefits explanations and clinical support to members and their dependents that have special needs. To better understand what you’re eligible for, log on to check your benefits, or refer to your Evidence of Coverage (EOC) or member handbook.
In addition, we created a list of organizations which provide support, information, and resources for both people with special health needs and those who care for them:
- Family TIES
- Massachusetts Family Voices
- Federation for Children with Special Needs
- Catalog of Health and Human Services
- Easter Seals
LGBTQ health + wellness
We pride ourselves in providing services that are innovative, compassionate and culturally sensitive for our members and their health care needs. Transgender services covered by Tufts Health Plan include gender affirming surgery, hormone therapy, and behavioral health services related to a member’s gender identity. We feel it is important to provide care that is essential to our LGBTQ members.
Family-centered Care
A commitment to do the right thing — to be there for you and your family — no matter what family looks like to you or how you define it.