TSS - Tufts Health Insurance Plan- Value Plan

Tufts Health Insurance Plan- Value Plan

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First Published  :Mon Dec 01 19:53:52 GMT 2014
Last Modified  :Wed Oct 10 14:53:35 GMT 2018
Last Published  :Wed Oct 10 14:53:35 GMT 2018
Summary :  Reference for benefits eligible employees who have inquiries about the Tufts Health Insurance options, specifically the Value Plan. Audience: Benefits Eligible Employees & Dependents


Primary Information

    Health Insurance – Value 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: 2018 Levels
    The Value Plan gives members the power to choose among and be covered for treatment by licensed physicians, specialists, and hospitals in or out of the Tufts Health Plan network. The plan incorporates a fee structure that requires some cost-sharing on your part including the highest deductible and co-payments of the three plans offered. In exchange, 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.

    You also get a value-based pharmacy option with no copayment on certain medications for certain chronic conditions.

    Choosing the Right Plan for You

    The value plan has:
    • In-network $35 office visit co-payment for either PCPs (primary care providers) or Specialists
    • Some in-network services  are subject to a deductible
    • If using out-of-network providers, you will pay a deductible and 20% coinsurance once deductible is met (the Plan pays 80% of the remaining bill).
    • In-network, preventive  care, like annual physicals, preventive testing, and immunizations, is covered 100% (no copayment)
    • Members of the Value plan also have the "Value Based Pharmacy" benefits see attached pamphlet , bottom of page 1 for more informaiton.  Certain medications are offered at no copayment for treatment of 5 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).
    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.  
    Please note that children of domestic partners can be added to plans.

    Group Number

    Most employees enrolled in the Value Plan have a group number of 48349-000.  However, for active employees who live in a different state and have the PHCS network, the group number is 48349-800.  
    Insurance cards are generally received in 10 business days once the provider receives the enrollment from Tufts University.

    Provider Contact Information
    For information on Physician selection, Health plan coverage, or claims contact:
    Tufts Health Plan
    1(844) 516-5790

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

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