Policies and Requirements

  • Your Rights and Responsibilities - As a Tufts Health Plan member, you have certain rights and responsibilities.
  • Appeals - As a Tufts Health Plan member, you can file an appeal with us about something we do or appeal a decision we make.
  • Complaints - As a Tufts Health Plan member, you can complain to MassHealth (link opens outside of Tufts Health Plan's website) or the Centers for Medicare & Medicaid (CMS)(link opens outside of Tufts Health Plan's website) if you’re unhappy about something we do.
  • Grievances - As a member, you have the right to file a grievance with Tufts Health Plan.
  • Notice of Privacy Policy - This policy explains how we protect our members’ information.
  • Advance Directives - The legal document that you can use to give your directions is called an advance directive. There are different types of advance directives and different names for them. Examples are a living will+ and a power of attorney+ for health care.
  • Referral Requirement for Specialty Services - A primary care provider (PCP) may need to give you a referral for certain specialty services to help you get the best care possible.
  • Out-of-network Coverage Guidelines - These guidelines list the rules for using out-of-network providers and facilities.
  • Contract Termination Information - This document explains that Medicare and the Executive Office of Health and Human Services must approve Tufts Health Unify each year.
  • Multi-language Insert - We can provide information to you in over 200 languages.
  • Prior Authorization Criteria for Prescription Drugs - This document helps you follow the correct prior authorization process for your prescription drugs.
  • Step-therapy Criteria for Prescription Drugs - This information helps you understand the step-therapy criteria for your prescription drugs.
  • Prescription Drug Transition Policy - This policy outlines the steps involved in transitioning your prescription drugs onto our plan.
  • Best Available Evidence Policy - (link opens outside of Tufts Health Plan's website) In certain cases, CMS systems do not reflect a beneficiary's correct low-income subsidy (LIS) status at a particular point in time. As a result, the most up-to-date and accurate subsidy information has not been communicated to the Part D plan. This policy outlines the process in place should this situation occur.
  • Fraud and Abuse - This information explain health care fraud and abuse.

Your Tufts Health Unify Member Handbook (PDF) includes most of the above information and much more. You can print a copy of the Member Handbook or call us at 855.393.3154 (TTY:711), seven days a week, from 8 a.m. to 8 p.m., to get a copy of the Member Handbook or any of the other attachments on this website sent to you. 

+Living will: A written document stating the medical care a person wants or does not want in the event the person becomes unable to speak his or her wishes.
Power of attorney: A written document in which one person gives another person the control to act for them in certain situations and functions.

H7419_4520_CMS Approved
Page modified on: 6/27/2017 7:56:13 PM

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