Plan Overview
Tufts Health Plan Navigator 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 but does not require members to select a Primary Care Provider (PCP). Members pay lower office visit copays when they see Tier 1 and 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/or cost; members pay a lower inpatient hospital copay when they use Tier 1 hospitals. Contact the plan to see which tier your hospital is in.
The mental health benefits of this plan, administered by Beacon Health Strategies effective July 1, 2013, offer you in-network benefits with a copay. Or, you may seek care from out-of-network providers, but at higher out-of-pocket costs.
Plan Contact Information
Medical Benefits:
Tufts Health Plan
1.800.870.9488
Mental Health, Substance Abuse and EAP Benefits:
Beacon Health Strategies 1-855-750-8980
Calendar Year Deductible
$250 per individual up to a maximum of $750 per family.
In-Network Copays Effective July 1, 2013
Primary Care Provider Office Visit
$20 per visit
Preventive Services
Most covered at 100% - no copay
Specialist Physician Office Visit
Tufts Health Plan tiers the following Massachusetts specialists based on quality and/or cost efficiency: Cardiologists, Dermatologists, Endocrinologists, Gastroenterologists, General Surgeons, Neurologists, Obstetrician/Gynecologists, Ophthalmologists, Orthopedists, Otolaryngologists (ENTs), Pulmonologists, Rheumatologists, and Urologists.
***Tier 1 (excellent): $25 per visit
**Tier 2 (good): $35 per visit
*Tier 3 (standard): $45 per visit
Out-of-State Specialist Office Visit: $35 per visit
Retail Clinic
$20 per visit
Outpatient Mental Health and Substance Abuse Care (See the Attached grid
Tufts Health Plan Navigator 
for additional benefit details.)
$20 per visit
UBH also offers EAP services.
Inpatient Hospital Care - Medical (Maximum one copay per person per calendar year quarter; waived if readmitted within 30 days in the same calendar year)
Tufts Health Plan tiers its hospitals for adult medical/surgical services, obstetrics, and pediatrics, based on quality and/or cost.
Tier 1: $300 per admission
Tier 2: $700 per admission
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:
Tufts Health Plan Navigator is available throughout Massachusetts.
The Plan is also available in the following other state:
Rhode Island
Tufts Health Plan Navigator is available only in certain parts of the following states; contact the plan to see if you live in the service area:
Connecticut, New Hampshire, New York, Vermont
Handbooks:
Tufts Health Plan Navigator Handbook - FY13 file size 2MB
Tufts Health Plan Navigator Handbook - FY13 
file size 1MB
This information provided by the Group Insurance Commission.
