- Advantage HMO Saver
- About Your Plan
- Choosing a PCP
- Getting Care
- Managing Costs
- Pharmacy Benefit
- Understanding HSAs
About Your Advantage HMO Saver PlanAdvantage Saver is a deductible plan designed to work with a Health Savings Account (HSA).
- Choosing a Primary Care Provider (PCP) from the Tufts Health Plan network of providers is the first step to good health. Click here to find a doctor.
- In most cases, your network PCP must provide the health care services you receive or authorize a referral for a specialist.
- If an emergency health situation arises, please call 911 or go to the nearest hospital for help. Your plan will always cover you for emergencies, regardless of where you are treated.
- Your plan has a deductible—an amount of money you need to pay out of your own pocket before your plan will begin to pay for non-routine covered services. All non-routine care, including prescription drugs, is subject to your plan’s deductible.
- Routine care, like annual physicals, preventive testing, and immunizations, is covered 100%. Your plan is designed to encourage routine care that helps keep you healthy.
- Once you meet your plan’s deductible, the plan pays for all covered services. This includes any prescriptions, office visits, hospital charges, diagnostic tests, and more. So with Advantage HMO Saver, you pay more of your costs upfront. But once the deductible is met, you will pay very little out of your own pocket.
- Costs for medical services vary greatly. You can estimate what your medical costs may be for your condition or procedure by using the "treatment cost estimator" tool in your secure account - log in to get started.
- Your plan also has an out-of-pocket maximum. After what you have paid out of your own pocket for your deductible, any copayments and coinsurance adds up to your plan’s out-of-pocket maximum amount, your don’t have to pay any costs out of your own pocket for covered services for the rest of your plan year.
The deductible does not apply for annual physicals and the routine tests your doctor orders as part of your checkup. If your doctor orders any additional tests and procedures that fall outside of those included with the annual physical, they may be subject to the deductible because they are not routine.
There is no individual deductible on a family plan. If you have two or more family members enrolled in the plan, the entire family deductible must be satisfied by one or more covered family members, before services subject to the deductible are covered. The same calculation applies to the out-of-pocket maximum.
Remember, you can find out the amount of your plan's deductible, and what services need a copayment, by logging in to your secure account.