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  :Tue Sep 10 13:23:26 GMT 2019
Last Published  :Tue Sep 10 13:23:26 GMT 2019
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

    2019 AccessTufts Benefits 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. Visit https://tuftshealthplan.com/tufts-university for more details.

    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 information.  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.

    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 Value Plan have a group number of 48349-000.

    Insurance cards 
    • New members and their dependents receive individual ID Cards within 10 business days of enrollment.
    • 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 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.
    Members of the Quality Tiered and Value plans also have a value-based pharmacy benefit - see attached pamphlet , bottom of page 1 for more information
    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). 

    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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