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 Tufts Health Plan's website) or the Centers for Medicare & Medicaid (CMS) (link opens outside 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 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.  and a power of attorney Power of attorney: A written document in which one person gives another person the control to act for them in certain situations and functions.  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 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 explains 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. 

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