TSS - Tufts Health Insurance Plan- Traditional Plan

Tufts Health Insurance Plan- Traditional Plan

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First Published  :Mon Dec 01 19:46:33 GMT 2014
Last Modified  :Tue Sep 10 13:22:34 GMT 2019
Last Published  :Tue Sep 10 13:22:34 GMT 2019
Summary :  Reference for benefits eligible employees who have inquiries about the Tufts Health Insurance options, specifically the Traditional Plan. Audience: Benefits Eligible Employees & Dependents


Primary Information

    2019 AccessTufts Benefits Information

    Health Insurance – Traditional 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 health coverage options at the following link:
    The Traditional Plan is for members who don’t want to worry about an in-network deductible or different provider Tiers – you’ll pay the same deductible every time you have an office visit with a provider in the Tufts Health Plan network. 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. It also provides a standard pharmacy benefit.  To learn more go to https://tuftshealthplan.com/tufts-university.  
    The traditional plan has:
    • In-network $25 office visit copayment for either PCPs (primary care providers) or Specialists
    • No in-network deductible
    • If using Out-of-network providers, you will pay a deductible and 20% coinsurance once deductible is met
    • In-network, preventive  care, like annual physicals, preventive testing, and immunizations, is covered 100% (no copayment)
    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.  
    Please note that children of domestic partners can be added to plans.

    See Employees Who Live Outside of THP Service Area for those who reside outside of MA, RI, NH.

    Group Number
    Most employees enrolled in the Traditional Plan will have a group number of 48350-000.  

    Insurance Cards
    • New members and their dependents receive individual ID Cards
    • If a Subscriber adds a dependent, a new ID card is sent for that dependent
    • Members who change plan type (Quality, Traditional, Value) will receive updated ID cards with updated group numbers
    • If a Subscriber and /or dependents move groups (Active to COBRA or Retiree), new ID cards are sent with new group numbers
    • Members don't need a physical ID card to use benefits. Providers can confirm coverage contacting THP Provider Services at 888-884-2404 with the member's SSN or Subscriber Id #.
    • Subscribers may request additional ID cards by contacting THP Member Services by phone 884-516-5790 or online via the secure member portal.
    • Members have the option to download the Tufts Health Plan Mobile App, which allows them to access a virtual ID card, check claims and cost-sharing responsibility, offers a provider search tool, and view costs and benefits.
    • Open Enrollment:  New ID cards are not re-issued every plan year, unless a new member is added (only the new addition will receive a card) or there is change to plan type (Quality, Traditional, Value).  2019 Open Enrollment:  ID cards for new members were mailed on 12/20/18.

    For all of our health plan options, Tufts Health Plan contracts with CVS Caremark as the Pharmacy Benefit Manager. For members seeking long term prescriptions, known as maintenance medications, these must be purchased at either a CVS Pharmacy or through the CVS Caremark mail order program for a 90 day supply.   For short term medication, 30 day supply, those may be filled at any pharmacy.
    The Traditional plan includes a Standard Pharmacy benefit (rather than the Value-based Pharmacy benefit included on the Quality Tiered and Value plans. The Value-based Pharmacy benefit on those plans offers no copayment on certain chronic condition medications

    Provider Contact Information
    For information on Physician selection, Health plan coverage, or claims contact:

     Tufts Health Plan
    844-516-5790. Member Specialists are available Monday through Thursday from 8:00 a.m. to 7:00 p.m., and Friday from 10:00 a.m. to 5:00 p.m.  Visit the Tufts University/Tufts Health Plan micro-site which provides a wealth of information. 


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