Plan Overview
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 but does not require 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.
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 will be administered by Beacon Health Strategies effective July 1, 2013.
! 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.
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.
Copays Effective July 1, 2012
Primary Care Physician 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
Retail Clinic
$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)
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 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:
Berkshire, Hampshire
Handbooks:
Tufts Health Plan Spirit FY13 Handbook 
file size 1MB
Tufts Health Plan Spirit FY13 Handbook file size 2MB
This information provided by the Group Insurance Commission.
