Plan Overview
NHP Care, administered by Neighborhood Health Plan, is an HMO that proivdes coverage through the plan’s network of doctors, hospitals, and other providers. Members must select a Primary Care Provider (PCP) to manage their care, including referrals to specialists. Members pay lower office visit copays when they see Tier 1 and Tier 2 physicians. Contact the plan to see how your provider is rated.
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.
! Your Responsibility
Do your doctors and hospitals participate in Neighborhood Health Plan?
Contact the Plan.
Plan Contact Information
Contact the plan for additional information on
participating providers and benefits.
Calendar Year Deductible
$250 per individual up to a maximum of $750 per family.
Copays Effective July 1, 2012
Primary Care Provider Office Visit
Neighborhood Health Plan tiers network Primary Care Physicians based on quality and/or cost-efficiency
***Tier 1 (excellent): $15 per visit
**Tier 2 (good): $25 per visit
*Tier 3 (standard): $30 per visit
Preventive Services
Most covered at 100% - no copay
Specialist Physician Office Visit
Neighborhood Health Plan tiers the following specialists based on quality and/or cost efficiency: Cardiologists, Endocrinologists, Gastroenterologists, Obstetrician/Gynecologists, Otolaryngologists (ENTs), Orthopedists, Pulmonologists, and Rheumatologists
***Tier 1 (excellent): $25 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
$25 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):
$250 per admission
Outpatient Surgery (Maximum four copays per person per calendar year)
$110 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, GIC Retired Municipal Teachers (RMTs), Elderly Governmental Retirees (EGRs), Survivors, and their eligible dependents without Medicare are eligible.
Where You Live Determines Which Plan You May Enroll In:
NHP Care is available in the following Massachusetts counties:
Barnstable, Bristol, Dukes, Essex, Hampden, Middlesex, Nantucket, Norfolk, Plymouth Suffolk, Worcester
Plymouth
Handbooks:
This information provided by the Group Insurance Commission.
