Healthcare Compass - Compare doctors' offices to get the best care. Use the Healthcare Compass tool to see how primary care providers in your area are rated by Massachusetts Health Quality Partners.
Your Rights and Responsibilities (PDF) - As a Tufts Health Plan member, you have certain rights and responsibilities.
Inquiries (PDF) - As a Tufts Health Plan member, you have the right to make an inquiry (ask a question or make a request) at any time about our operations.
Member Appeals Process (PDF) - As a Tufts Health Plan member, you can appeal a decision we make.
Notice of Privacy Practices (PDF) - We protect our members' information.
Advance Directives (PDF) - Advance directives are written instructions, sometimes called a living will or durable power of attorney, to make your wishes known about medical treatments.
Quality Improvement Work Plan Summary (PDF) - Our quality program helps us make sure you get the right care, at the right time and the right place.
Referral Requirement for Specialty Services (PDF) - You may need a primary care provider (PCP) referral for certain specialty services to help us make sure you get the care you need.
Consumer Assistance - The consumer assistance program in Massachusetts can help you file your appeal.
Fraud and Abuse - Help reduce health care fraud and abuse.
Medical Necessity Guidelines - Medical Necessity Guidelines are used to determine coverage for services requiring prior authorization.
Behavioral Health Medical Necessity Guidelines - Behavioral Health Medical Necessity Guidelines are used to determine coverage for behavioral health services requiring prior authorization.
Pharmacy Medical Necessity Guidelines - Pharmacy Medical Necessity Guidelines are used to determine coverage for drugs requiring prior authorization.
Forms - Find the main forms you may need as a Tufts Health Direct member here.
Your Tufts Health Direct Member Handbook 2023 | 2022 (PDF) also includes most of the above information. To get a printed copy of our Member Handbook or any of the other above attachments, please call us at 888-257-1985.