- Advantage PPO Saver
- About Your Plan
- Getting Care For Your Advantage PPO Plan
- Managing Costs
- Pharmacy Benefit
- Understanding HSAs
- Visiting the Doctor
About Your Advantage PPO Saver PlanAdvantage Saver is a deductible plan designed to work with a Health Savings Account (HSA).
- You have the freedom to see any doctor that you choose. Receive covered health care services from most licensed providers in or out of the Tufts Health Plan network.
- Routine care, like annual physicals, preventive testing, and immunizations, is covered 100%. Your plan is designed to encourage routine care that keeps you healthy.
- Your plan has a deductible—an amount of money you need to pay out of-pocket before health insurance coverage kicks in. You will have to pay for any non-routine health services you receive—including prescriptions, office visits, and hospital charges—until you have paid an amount equivalent to your yearly deductible.
- Once you meet your plan’s deductible, the plan pays for many covered services (a small copayment may apply). This includes any office visits, hospital charges, diagnostic tests, and more. So with Advantage PPO Saver, you pay more of your costs upfront. But once the deductible is met, you will pay very little out of your own pocket.
- If you go to a doctor who is outside of the Tufts Health Plan network, you are required to pay coinsurance—a percentage of the reasonable charge of the service, up to your out-of-pocket maximum. (you may also be responsible for charges above the reasonable charge for the service). Your out-of-pocket maximum is the most money you will have to pay out of your own pocket for covered health expenses in any one-year period. Once you’ve met your out-of-pocket maximum, Tufts Health Plan will pay your covered services in full.
- Costs of 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!
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 and only one member receives services that are subject to the deductible in a plan year, that member alone must meet the full family deductible before services subject to the deductible are covered. The same calculation applies to the out-of-pocket maximum.