Plan Overview

The Harvard Pilgrim Independence Plan, administered by Harvard Pilgrim Health Care, is a PPO plan that offers coverage through network doctors, hospitals and other health care providers with a copay.  Or, you may seek care from an out-of-network provider for 80% coverage of reasonable and customary charges. The plan encourages members to select a Primary Care Provider (PCP). Members pay lower office visit copays when they see Tier 1 or Tier 2 specialists.  Contact the plan to see if your provider is in the network and how he/she is rated.

The plan also tiers hospitals based on quality and and/or cost; members pay a lower inpatient hospital copay when they use Tier 1 or Tier 2 hospitals.  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

Calendar Year Deductible

$250 per individual up to a maximum of $750 per family. 

In-Network Out-Of-Pocket Maximum

Excludes Prescription Drug Costs

$5,000 per individual; $10,000 per family

In-Network Copays Effective July 1, 2014

Primary Care Provider Office Visit

 $20 per visit

Preventive Services

Most covered at 100% - no copay

Specialist Physician Office Visit

Harvard Pilgrim Health Care  tiers the following Massachusetts specialists based on quality and/or cost efficiency: Allergists/Immunologists, Cardiologists, Dermatologists, Endocrinologists, Gastroenterologists, General Surgeons, Neurologists, Obstetricians/Gynecologists, Ophthalmologists, Orthopedists, Otolaryngologists (ENTs), Pulmonologists, and Rheumatologists. Contact the plan to see how your provider is rated.
***Tier 1 (excellent):  $20 per visit
 **Tier 2 (good):       $35 per visit
   *Tier 3 (standard):   $45 per visit

Retail Clinic

$20 per visit

Outpatient Mental Health and Substance Abuse Care

$20 per individual 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)

Harvard Pilgrim Health Care tiers its hospitals based on quality and/or cost:

Tier 1:   $250 per admission

Tier 2:   $500 per admission

Tier 3:   $750 per admission

Contact the plan to see which tier your hospital is in.

Outpatient Surgery (Maximum four copays per person per calendar year)

$150 per occurrence

High-Tech Imaging (e.g., MRI, PET and CT scans) (Maximum one copay per day)

$100 per scan

Emergency Room
$100 per visit (waived if admitted)

Prescription Drug

Retail up to 30-day supply:      Mail Order up to 90-day supply:
Tier 1:   $10                            Tier 1:   $20
Tier 2:   $25                            Tier 2:   $50
Tier 3:   $50                            Tier 3:   $110

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:

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:

Connecticut, New York, Vermont

Handbook

Harvard Pilgrim Independence Plan FY15 Benefit Handbook doc format of HPHCIndependenceFY15.doc

Harvard Pilgrim Independence Plan FY15 Benefit Handbook pdf format of HPHCIndependenceFY15.pdf

Harvard Pilgrim Independence Plan FY15 Prescription Drug Brochure doc format of HPHCIndependenceRxFY15.doc

Harvard Pilgrim Independence Plan FY15 Prescription Drug Brochure pdf format of HPHCIndependenceRxFY15.pdf

Harvard Pilgrim Independence Plan FY15 Schedule of Benefits doc format of hphcIndependenceSOBfy15.doc
 

Harvard Pilgrim Independence Plan FY15 Schedule of Benefits pdf format of HPHCIndependenceSOBfy15.pdf
  


This information provided by the Group Insurance Commission .