Plan Overview

Harvard Pilgrim Medicare Enhance is a supplemental Medicare plan, offering coverage for services provided by any licensed doctor or hospital throughout the United States that accepts Medicare payment.

Effective July 1, 2017, members will be automatically enrolled in Medicare Part D as the prescription drug benefit of this plan transitions to an Employer Group Waiver Plan (EGWP) under contract with the federal government along with extra coverage from the GIC.  The program will be administered by SilverScript.  See the benefit change section for details.

Plan Contact Information

Medical Benefits

Harvard Pilgrim Medicare Enhance 1.800.542.1499

Prescription Drug Benefits
SilverScript

1.877.876.7214 TDD: 1-800-238-0756

Copays Effective July 1, 2017  

Preventive Services

Covered at 100% - no copay

Physician Office Visit 
$15 per visit

Retail Clinic

$15 per visit

Outpatient Behavioral Health and Substance Use Disorder Care

$10 per visit

Inpatient Hospital Care

Covered at 100% - no copay

Inpatient and Outpatient Surgery
Covered at 100% - no copay

Emergency Room
$50 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:   $25
Tier 2:   $30                                         Tier 2:   $75
Tier 3:   $65                                         Tier 3:   $165

Who is Eligible?

Retirees, GIC Retired Municipal Teachers (RMTs), Elderly Governmental Retirees (EGRs), Survivors, and their eligible dependents with Medicare Part A and Part B are eligible.

Where You Live Determines Which Plan You May Enroll In:

The Harvard Pilgrim Medicare Enhance Plan is available throughout the United States.

FY18 Harvard Medicare Enhance Handbook  pdf format of FY18 Harvard Medicare Enhance Handbook
file size 1MB

FY17 Harvard Medicare Enhance Schedule of Benefits  pdf format of FY17 Harvard Medicare Enhance Schedule of Benefits

FY18 Harvard Medicare Enhance Prescription Drug Brochure  pdf format of FY18 Harvard Medicare Enhance Prescription Drug Brochur

Preventive Services Covered by Harvard Medicare Enhance  pdf format of Preventive Services Covered by Harvard Medicare Enhance

If you need ADA accommodation to access these materials or are unable to download the attached version of the handbook, contact Harvard Pilgrim:

New members: 1-800-542-1499; email

Current members: 1-888-333-4742; email

 


This information provided by the Group Insurance Commission .