Plan Overview

Health New England MedPlus is a Medicare HMO plan that provides coverage through the plan’s network of doctors, hospitals, and other providers.  Members must select a Primary Care Physician (PCP) to manage their care; referrals to network specialists are not required. 

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. 

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.

Your Responsibility

Do your doctors and hospitals participate in Health New England MedPlus?

Contact the plan.

Plan Contact Information

Medical Benefits

Health New England MedPlus 1.800.842.4464

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

$15 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:

Health New England MedPlus is available in the following Massachusetts counties:

Berkshire, Franklin, Hampden, Hampshire, Worcester

Health New England MedPlus is available only in certain parts of the following state; contact the plan to find out if you live in the service area:  Connecticut

Health New England January 1, 2016 Amendment

Handbook:

Health New England MedPlus FY17 Handbook  docx format of Health New England MedPlus FY17 Handbook
file size 1MB

Health New England MedPlus FY17 Handbook  pdf format of Health New England MedPlus FY17 Handbook
file size 1MB

Health New England MedPlus FY17 Schedule of Benefits  doc format of Health New England MedPlus FY17 Schedule of Benefits

Health New England MedPlus FY17 Schedule of Benefits  pdf format of Health New England MedPlus FY17 Schedule of Benefits


This information provided by the Group Insurance Commission .