For More Information
See Frequently Asked Questions on medical and dental coverage.
An HMO plan is a health care plan in which a network of health care providers delivers managed care at a center or as part of a network. Participants are required to choose a primary-care physician (PCP) from the plan's network of doctors. The PCP provides or authorizes most of your care, except in cases of emergency and certain other situations as outlined in your member handbook. You choose a PCP for yourself and for each covered family member to coordinate the care you receive. For more specialized care, your PCP will select and refer you to a Tufts Health Plan network specialist, usually one who practices with your doctor’s provider group.
The Tufts Preferred Provider Organization (PPO) allows participants to manage their own health care without having to select a primary-care physician. The PPO offers two kinds of care under one plan. If you choose a provider within the Tufts network for covered services, you pay only for the office visit copayment. If you choose a provider outside the Tufts network, you pay a deductible for covered services, after which you will be responsible for paying the coinsurance for covered services up to the out-of-pocket maximum.
Massachusetts Health-Care Reform
Tufts HMO Value Plan
- 2014Tufts HMO Value Evidence of Coverage (PDF)
- 2013Tufts HMO Value Evidence of Coverage (PDF)
- 2014 Tufts HMO Value Summary of Benefits Coverage (PDF)
Tufts HMO Premium Plan
- 2014 Tufts HMO Premium Evidence of Coverage (PDF)
- 2013 Tufts HMO Premium Evidence of Coverage (PDF)
- 2014 Tufts HMO Premium Summary of Benefits Coverage (PDF)
Tufts PPO Documents
- 2014 Tufts PPO Evidence of Coverage (PDF)
- 2013 Tufts PPO Evidence of Coverage (PDF)
- 2014 Tufts PPO Premium Summary of Benefits Coverage (PDF)