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  :Thu Oct 19 20:29:54 GMT 2017
Last Published  :Thu Oct 19 20:29:54 GMT 2017
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

    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: 2017 Chart.
    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.
    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)
    • Standard Pharmacy Benefit (information on bottom of page 1 for Value Based Pharmacy only applies to Quality Tiered and Value plans NOT Traditional) Tufts Pharmacy Tiered Program 2017  
    •  Tufts Pharmacy Maintenance Choice Flyer 2017- information about 90 day prescriptions through CVS/CareMark
    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 qualified domestic partners can be added to plans.

    Group Number
     Insurance cards are generally received in 10 business days once the provider receives the enrollment from Tufts UniversityMost employees enrolled in the Traditional Plan will have a group number of 48350-000.  However, active employees who lives in a different state than MA and have the PHCS network will have a group number of 48350-800.

    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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