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Frequently Asked Questions
Here are some frequently asked questions about Tufts Health Direct, our focused-network plan for individuals and small groups:
As a Tufts Health Direct member, you need to notify Tufts Health Plan and the Health Connector when your mailing address changes, or you could lose your health plan benefits. To update your mailing address, call us at 888-257-1985 (TTY: 888-391-5535), Monday through Friday, from 8 a.m. to 5 p.m., or call the Health Connector at 877-623-6765 (TTY: 877-623-7773), Monday through Friday, from 8 a.m. to 6 p.m.
To choose or change your PCP, or to check if your doctor needs to get prior authorization (permission) for you to get a service, log in to Tufts Health Member Connect, our self-service tool, or sign up if you don’t already have an account. All you need to create an account is your Tufts Health Plan member ID number and date of birth. If you do not know your member ID number, check your member ID card.
If there are changes to your eligibility criteria that may allow you to change your coverage type (e.g., qualifying event), call the Health Connector at 877-623-6765 (TTY: 877-623-7773), Monday through Friday, from 8 a.m. to 6 p.m., or visit MAHealthConnector.org.
Tufts Health Direct uses a Preferred Drug List (PDL) as our list of covered drugs. To quickly find out if we cover a specific drug, look it up in our PDL. We update the PDL every three months. The PDL applies only to drugs you get at retail, specialty, and mail-order pharmacies if covered under your plan level. The PDL does not apply to drugs you get if you are in the hospital.
Learn more about Tufts Health Direct cost-sharing terms.
As part of our care-management program, if you have a physical disability or other special health condition such as a high-risk pregnancy, cancer, HIV/AIDS, or a behavioral health (mental health and/or substance abuse) concern, our clinicians can give you information, personalized resources (if eligible), and help coordinating your care. We also offer social care management services to help arrange, coordinate, and evaluate the services you may need; disease-management programs for asthma and diabetes; and health-coaching services if you have a chronic health condition.
For more on these services, check our Tufts Health Direct Member Handbook (PDF).
- Cosmetic surgery
- Hearing aids for members over age 21
- Long-term care
- Nonemergency dental services (excluding cleft palate/lip services for members under age 18
- Nonemergency care when traveling outside the U.S.
- Private-duty nursing
- Vocational rehabilitation
- Any service or supply that is not medically necessary
For a complete list of services we do not cover, check our Tufts Health Direct Member Handbook (PDF).
For added convenience, you may be able to pay electronically and set up recurring payments, where you can authorize your monthly premium to be deducted directly from your checking account. This means not having to worry about writing and mailing a check every month.
For more information about Tufts Health Direct premium payments, check your invoice.
For a copy of our Notice of Privacy Practices, call us at 888-257-1985 (TTY: 888-391-5535), Monday through Friday, 8 a.m. to 5 p.m. You can also find this information online and in our Tufts Health Direct Member Handbook (PDF).
Call us at 888-257-1985, Monday through Friday, 8 a.m. to 5 p.m. We're happy to help.