|The Harvard Pilgrim Independence Plan is closed to new members. See the Benefit Change section for more information.|
The Harvard Pilgrim Independence Plan, administered by Harvard Pilgrim Health Care, is a POS plan that that provides coverage for treatment by a network of doctors, hospitals and other health care providers. Members must select a PCP to manage their care and obtain referrals to specialists to receive care at the in-network level of coverage. It also allows treatment by out-of-network providers or in-network care without a Primary Care Provider (PCP) referral, but with higher out-of-pocket costs.
Primary Care Provider (PCP), Specialist, and Hospital Tiering Changes
Harvard Pilgrim is implementing PCP tiering and changing its tiering program to one based on provider group value instead of individual performance. This change may affect your copays. Members will pay lower copays for Tier 1 and Tier 2 PCPS and specialists and Tier 1 and Tier 2 hospitals. Contact the plan to see each of your provider’s tiers for the office location you visit. Also contact the plan to see which tier your hospital is in.
Plan Contact Information
Contact the plan for additional information on participating providers and benefits.
Harvard Pilgrim Health Care 1.800.542.1499
$500 per individual/$1,000 per family.
Prescription Drug Deductible
$100 per individual/$200 per family
In-Network Out-Of-Pocket Maximum
$5,000 per individual; $10,000 per family
In-Network Copays Effective July 1, 2017
Primary Care Provider Office Visit
Tier 1: $10 per visit
Tier 2: $20 per visit
Tier 3: $40 per visit
Most covered at 100% - no copay
Specialist Physician Office Visit
Contact the plan to see how your provider is rated.
Tier 1: $30 per visit
Tier 2: $60 per visit
Tier 3: $90 per visit
$20 per visit
Outpatient Behavioral Health and Substance Use Disorder Care
$10 per visit
Inpatient Hospital Care - Medical (Maximum one copay per person per calendar year quarter; waived if readmitted within 30 days in the same calendar year)
Tier 1: $275 per admission
Tier 2: $500 per admission
Tier 3: $1,500 per admission
Contact the plan to see which tier your hospital is in.
Outpatient Surgery (Maximum four copays per person per calendar year)
$250 per occurrence
High-Tech Imaging (e.g., MRI, PET and CT scans) (Maximum one copay per day)
$100 per scan
$100 per visit (waived if admitted)
Retail up to 30-day supply: Mail Order up to 90-day supply:
Tier 1: $10 Tier 1: $25
Tier 2: $30 Tier 2: $75
Tier 3: $65 Tier 3: $165
Who is Eligible?
Employees, Retirees, Survivors, and their eligible dependents without Medicare are eligible.
Where You Live Determines Which Plan You May Enroll In
The Harvard Pilgrim Independence Plan is available throughout Massachusetts.
The plan is also available in the following other states:
Connecticut, Maine, New Hampshire, Rhode Island
The Harvard Pilgrim Independence Plan is available only in certain parts of the following states; contact the plan to find out if you live in the service area:
New York, Vermont
FY18 Harvard Independence Handbook file size 2MB
If you need ADA accommodation to access these materials or are unable to download the attached version of the handbook, contact Harvard Pilgrim:
New members: 1-800-542-1499; email
Current members: 1-888-333-4742; email
This information provided by the Group Insurance Commission .