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Member Welcome Kit

HMO plan and benefit information in a format for you to save or print.

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HMO - Health Maintenance Organization

Great Coverage at a Great Price

Not all health plans work the same way. This website will explain how the Tufts Health Plan HMO plan works, so be sure to read through it carefully to understand your plan.
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You can also visit mytuftshealthplan.com, our secure members-only site, to learn the details of the specific plan your employer has chosen for you. And be sure to read your Benefit Document, available at mytuftshealthplan.com, to see a complete list of your specific plan’s covered and non-covered benefits.

Knowledge is power, and knowing how your plan works will give you the power to plan for and control your out-of-pocket costs.

The Tufts Health Plan HMO plan is known by many different names. These include Choice Copay Platinum, Basic 25, Value, Premium and Select 20. There are other names too, but the overall idea behind all of these HMO plans is to enable employers to offer high-quality health care to their valuable employees (you). The Tufts Health Plan HMO plan helps accomplish this by incorporating a fee structure that requires some cost-sharing on your part.

This cost-sharing is primarily in the form of a copay.

The Copay

With the Tufts Health Plan HMO plan, there is no deductible that needs to be met. However, there are some services that may require a copay. A copay is a fee that you pay as partial payment for certain services. For instance, a visit to the doctor’s office often requires a copay. That means you pay, for example, $20 out-of-pocket as your copay.

If a copay is required for the type of medical service you want, you are responsible for the copay. Again, the best way to control out-of-pocket costs is to read this Member Kit so you understand what you are and what you are not responsible for.

And you can always find out exactly what your specific plan covers by reading your Benefit Document or accessing your secure member account at mytuftshealthplan.com.

A Word About Coinsurance

There’s one more component of the Tufts Health Plan HMO plan’s fee structure that bears mentioning. It’s called coinsurance, and it applies primarily to durable medical equipment (such as a wheelchair or crutches), hearing aids, low-protein foods and prosthetics. If you require any of those items, you would share a percentage of the cost.

In some cases, coinsurance may also apply to other items. You can find the specifics of your plan, including the exact amount of your coinsurance, by reading your Benefit Document or by visiting mytuftshealthplan.com.

The Out-of-pocket Maximum

You’ll be glad to know there’s a limit on what you may possibly pay during a calendar year. It’s called an Out-of-Pocket maximum. The Out-of-Pocket maximum is the most you can pay during your coverage period (typically one year) for your share of the cost of covered services.

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