Tufts Health Public Plans

Plans and product overview

Note: This information is intended to provide an overview. Providers are reminded to check the member’s ID card to verify the plan in which the member is enrolled. Services and subsequent payment are pursuant to the member's benefit plan document. Prior to initiating services, member eligibility and benefits should be verified by logging on to the secure Provider website.

For information on Complaints, Grievances and Appeals processes see the Complaints, Grievances and Appeals page.

General benefit information

Most plans cover appropriately authorized, medically necessary services in full, minus the applicable copayment, deductible and/or coinsurance. Coverage of services and subsequent payment are based on Tufts Health Public Plans medical and behavioral health benefit summary grids.

Authorization of services

Prior authorizations are required for certain services. To find detailed information about prior authorization requirements, refer to the Tufts Health Public Plans medical and behavioral health benefit summary grids.

Pharmacy

For information on pharmacy copayments, preferred drug lists and pharmacy updates, refer to the Tufts Health Public Plans Pharmacy section or the Pharmacy chapter in the Provider Manual.

Behavioral health

Tufts Health Plan authorizes medically necessary behavioral health services as defined by the member’s benefit plan document. For more information, refer to the Behavioral Health section or the Behavioral Health chapter in the Provider Manual.