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EPO - Exclusive Provider Option

A high-quality plan that’s easy to use

Tufts Health Plan’s EPO is a high-quality plan that’s easy to use. It is a self-insured product that works just like our HMO. Members will choose a Primary Care Provider (PCP) from our extensive network throughout Massachusetts, Rhode Island, and New Hampshire. There are no claim forms to fill out. Most services are covered with just a copayment.

The EPO plan features:

  • A network of approximately 25,000 providers and 90 hospitals
  • Wellness and disease management programs to help keep members healthy while controlling costs
  • Discounts on fitness club memberships, acupuncture, massage, and more

How the Plan Works

EPO members must choose a PCP from our network of providers, who will provide or coordinate all of the member’s care. Then, the member presents his or her ID card at each office visit, and pays the applicable copayment.

For care from a specialist, the PCP will refer the member to a specialist within our network. A member is required to obtain a referral in order to receive coverage for the specialist’s services.

Pharmacy Coverage

If your plan includes the optional pharmacy benefit, members will pay a copayment for each prescription, according to our three-tier pharmacy copayment program:

  • Tier 1: Lowest copayment; includes most generic drugs
  • Tier 2: Middle copayment; includes many brand-name drugs
  • Tier 3: Highest copayment; includes the most costly covered brand-name drugs not included in other tiers.

Superior Customer Service

Our Member Services department offers your employees a staff of highly trained professionals. One phone call is all it takes to reach our Member Specialists. They are available to answer members’ questions about the plan and their benefits. We also offer language translation services and TTY capabilities as needed.

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