- About Your Advantage HMO Plan
- Choosing a PCP
- Getting Care
- Managing Costs
- Pharmacy Benefit
- Plan FAQs
- Understanding HRAs
Getting Care With Your Advantage HMO PlanRoutine Medical Care - regular office visits to your PCP for medical issues, physical exams, and preventive tests.
- Just show your Tufts Health Plan member ID card and pay your copayment amount
- You do not need a PCP referral for the following services if received by an in-network provider:
- Preventive mammography screening
- Maternity care
- OB/GYN visits
- Routine eye exams (if you have this benefit)
- Emergency care
Specialty Care – office visits with a specialist (surgeon, cardiologist, neurologist, etc.)
- Make an appointment with your PCP for an initial assessment. If necessary, your PCP will refer you to an in-network specialist.
- Just show your Tufts Health Plan member ID card and pay your copayment amount.
- If you need to be admitted to the hospital for non-emergency services, your PCP will refer you, authorize, and coordinate all your hospital care.
- If you need to be hospitalized, it's likely you'll be admitted to your PCP's hospital, unless the treatment you need is unavailable there.
- If you are hospitalized for emergency care, you should call your PCP or Tufts Health Plan within 48 hours of admission.
- Seek immediate care at the nearest emergency facility anywhere in the world; call 911, or your local emergency medical services phone number.
- Emergency medical care is covered, whether or not you receive the care from a provider in our network.
- You do not need a PCP referral to receive emergency care.
- If you are hospitalized after receiving emergency care, you should call your PCP or Tufts Health Plan within 48 hours of admission.
- If you are not hospitalized, notify your PCP of your emergency within 48 hours of receiving care, so that he or she can provide or arrange for any follow-up care you may need.
If your employer chose to offer pharmacy coverage through Tufts Health Plan, you will pay a copayment for each prescription, according to our three-tier pharmacy copayment program:
- Tier 1: This is the lowest copayment and includes most generic drugs
- Tier 2: This is the middle copayment and primarily includes brand-name drugs selected for Tier 2
- Tier 3: This is the highest copayment and includes covered drugs not selected for Tier 2