Tufts Health Plan Spirit is an Exclusive Provider Organization (EPO) plan that provides coverage through the plan’s network of doctors, hospitals and other providers. The plan encourages members to select a Primary Care Provider (PCP).
Contact the plan to see if your doctors and hospitals are in the network. There are no out-of-network benefits, with the exception of emergency care.
Specialist and Hospital Tiering Changes
Tufts Health Plan is 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 specialists and Tier 1 hospitals. Contact the plan to find out each of your provider’s tier at the office location you visit. Also contact the plan to see which tier your hospital is in.
! Your Responsibility
Do your doctors and hospitals participate in Tufts Spirit?
Contact the Plan.
Plan Contact Information
Contact the plan for additional information on
participating providers and benefits.
$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
Copays Effective July 1, 2017
Primary Care Physician Office Visit
$20 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
Retail Clinic and Urgent Care Center
$20 per visit
Outpatient Mental Health and Substance Abuse Care (See the attached grid Tufts Health Plan Spirit for additional benefit details.)
$20 per visit
Beacon 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)
Tier 1: $300 per admission
Tier 2: $700 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
Tufts Health Plan Spirit is available in the following Massachusetts counties:
Barnstable, Bristol, Essex, Franklin, Hampden, Middlesex, Norfolk, Plymouth, Suffolk, Worcester
Tufts Health Plan Spirit is available only in certain parts of the following Massachusetts counties; contact the plan to find out if you live in the service area:
FY17 Tufts Spirit EPO Handbook file size 52MB
FY17 Tufts Spirit EPO Handbook file size 1MB
This information provided by the Group Insurance Commission .