TSS - Tufts Health Insurance Plan- Quality Tiered Plan

Tufts Health Insurance Plan- Quality Tiered Plan

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First Published  :Mon Dec 01 19:35:39 GMT 2014
Last Modified  :Mon Jul 17 14:06:17 GMT 2017
Last Published  :Mon Jul 17 14:06:17 GMT 2017
Summary :  Reference for benefits eligible employees who have inquiries about the Tufts Health Insurance options, specifically the Quality Tiered Plan. Audience: Benefits Eligible Employees & Dependents

Response

Primary Information

    Health Insurance – Quality Tiered Plan
    Eligible employees and their family members may elect health benefits and choose from 3 health coverage options, at 3 different coverage levels (individual, 2-person, family). All options are administered by Tufts Health Plan.  You can view a side-by-side comparison of the health coverage options at the following link:   2017 Comparison Chart. 

    The Quality Tiered Health Plan is designed for employees who are interested in using and knowing which providers are providing the most efficient care. Employees can use the entire Tufts Health Plan Preferred Provider Option (PPO) network, but when you utilize “TU Preferred” providers, your co-payments are lower. Since this is a Preferred Provider Organization (PPO) type of health plan, you have the freedom to see any provider – in or out of the Tufts Health Plan network – without required referrals.This plan also includes a value-based pharmacy option with no copayment on medications for certain chronic conditions.

    All hospitals and the affiliated doctors in Tufts Health Plan’s network have been assigned a “Tier” based on their quality and cost. To help keep your health care affordable, we have partnered with certain providers to give you the option of getting high-quality care at a lower cost. You pay the lowest out-of-pocket costs when you receive services from Tier 1 providers.
    • TIER 1—“TU Preferred” providers: There is not an annual deductible and office visit copayments for a PCP or Specialist are $15
    • TIER 2—“In-Network” providers: There is an annual deductible which applies to certain services and office visit copayments for a PCP or Specialist are $25
    • TIER 3—“Out-of-Network”: A higher annual deductible and you will pay 20% coinsurance once deductible is met for services (the Plan pays 80% of the remaining bill).
    Note that you are not “locked” into a Tier. If you are in this plan, you (and your family members) can decide to use Tier 1, Tier 2, or Tier 3 providers each and every time you need care. For example, you can use  a Primary Care Provider (PCP) who is a TU Preferred provider and that your specialist is a Tier 2 provider. The choice is yours. Depending on what tier you select for each service, the corresponding cost share will apply.  Note that in most cases the individual provider at a Tier 1 hospital would also be Tier 1 however there are always exceptions.  To confirm the provider's Tier, please to go to https://tuftshealthplan.com/microsites/tufts-university/network or call THP.

    Members of this plan also have a value-based pharmacy benefit - see attached pamphlet , bottom of page 1 for more informaiton. (2017). 
    Certain medications offered at no copayment for treatment of five specific common chronic conditions (diabetes, asthma and chronic obstructive pulmonary disease (COPD), coronary artery disease (high blood pressure and high cholesterol), depression, and heart failure). 
     
    All of the hospitals in the Tufts Health Plan network meet our quality standards. All hospitals in MA and RI are included in the Tufts Health Plan network.  As part of our National Committee for Quality Assurance (NCQA) accreditation and our own quality initiatives, Tufts Health Plan is committed to contracting with a network of high- performing hospitals. The quality of the network hospitals is reviewed periodically through Tuft’s Health Plan’s  re- credentialing process and quality assurance programs. Tiering will be updated on an annual basis to reflect changes in hospital quality or cost based on the measures used by the Tufts Health Plan Clinical Review Team.
     
     
    Preferred Hospitals List

    A list of “TU Preferred” (Tier 1) Hospitals can be accessed at the following link: TU Preferred” (Tier 1) Hospitals
    To find out which Hospitals are considered Tier 2, please contact Tufts Health Plan at (844) 516-5790.
    Insurance cards are generally received in 10 business days once the provider receives the enrollment from Tufts University.


    Visit the Tufts University/Tufts Health Plan micro-site which provides a wealth of information.  Or specifically for Prescription information, click here.

    Eligibility-If you do not enroll within 31 days of the date you are first eligible, you will not be able to enroll until the next annual open enrollment, unless you experience a Qualified Status Change. See Change in Benefits Election after Change in Life Status (Qualified Status Changes)
    All active, regular employees at the University are eligible, provided that you are an exempt or non-exempt employee regularly scheduled to work 17.5 hours or more a week, with a minimum 90 days employment period. 
    or faculty member with at least a half time (as determined by the academic department), two- semester appointment
    See pages 5-8 of the Summary Plan Description for Benefits Eligible Employees for full Eligibility information for Staff, Faculty, Dependents, and Retirees. See also Aging Out at 26 - Dependents with Disabilities.  Please note that children of qualified domestic partners can be added to plans.


    Provider Contact Information
    For information on Physician selection, Health plan coverage, or claims contact Tufts Health Plan.
     
    Group Number 

    Insurance cards are generally received in 10 business days once the provider receives the enrollment from Tufts University. For most employees, the group number of Quality Tiered Plan is 48347-000.  

    Tufts Health Plan
    (844) 516-5790
    http://www.tuftshealthplan.com/tuftsuniversity

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Keywords

    Health insurance, medical, quality, tiered, doctors, prescriptions, ID cards, benefits, health, age 26