The Navigator by Tufts Health Plan is closed to new members. See the Benefit Change section for more information.

Plan Overview

Navigator by Tufts Health Plan is a POS plan that that provides coverage for treatment by a network of doctors, hospitals and other health care providers.  Members must select a PCP to manage their care and obtain referrals to specialists to receive care at the in-network level of coverage. It also allows treatment by out-of-network providers or in-network care without a Primary Care Provider (PCP) referral, but with higher out-of-pocket costs.

The Behavioral health benefits of this plan, administered by Beacon Health Options, offer you in-network benefits with a copay.  Or, you may seek care from out-of-network providers, but with higher out-of-pocket costs.

Primary Care Provider (PCP), Specialist, and Hospital Tiering Changes

Tufts Health Plan is implementing PCP tiering and 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 PCPS and specialists and Tier 1 and Tier 2 hospitals.  Contact the plan to see each of your  provider’s tiers for the office location you visit.   Also contact the plan to see which tier your hospital is in.

Plan Contact Information

Contact the plan for additional information on participating providers and benefits.

Medical Benefits:
Tufts Health Plan
1.800.870.9488

Behavioral Health, Substance Use Disorder and EAP Benefits:
Beacon Health Options 1.855.750.8980

Fiscal Year Deductible

Medical Deductible
$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

In-Network Copays Effective July 1, 2017

Primary Care Provider Office Visit

Tier 1:    $10 per visit
Tier 2:    $20 per visit
Tier 3:    $40 per visit

Preventive Services

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 Behavioral Health and Substance Use Disorder Care (See the attached grid Tufts Health Plan Navigator docx format of Beacon_Tufts_NavigatorFY18.docx
for additional benefit details.)

$10 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:   $275 per admission

Tier 2:   $500 per admission

Tier 3:   $1,500 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

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:   $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 Navigator is available throughout Massachusetts.

The Plan is also available in the following other state:

Rhode Island

Tufts Health Plan Navigator is available only in certain parts of the following states; contact the plan to see if you live in the service area:

Connecticut, New Hampshire, New York, Vermont

Handbook

FY17 Tufts Navigator POS handbook doc format of FY17 Tufts Navigator POS handbook
file size 53MB pdf format of                             FY17 Tufts Navigator POS handbook                file size 1MB


This information provided by the Group Insurance Commission .