GIC Health Plan Options

Harvard Pilgrim Independence Plan
Eligibility
Plan Contact Information
Plan Service Area

Plan Overview
The Harvard Pilgrim Independence Plan, administered by Harvard Pilgrim Health Care, is a PPO plan that does not require members to select a Primary Care Physician (PCP). The plan offers you a choice of using network providers and paying a copayment, or seeking care from an out-of-network provider for 80% coverage of reasonable and customary charges, after you pay a deductible. Members pay lower office visit co-pays when they see Tier 1 or Tier 2 physicians.  Contact the plan to see if your provider is in the network and how he/she is rated.


In-Network Benefits Effective July 1, 2008

Primary Care Physician Office Visit (Internal medicine, family practice and pediatrics)
100% after $15 per visit

Specialist Physician Office Visit
Harvard Pilgrim Health Care tiers the following specialists based on quality and cost efficiency: Allergists/Immunologists, Cardiologists, Dermatologists, Enocrinologists, Gastroenterologists, General Surgeons, Neurologists, Obstetrician/Gynecologists, Ophthalmologists, Orthopedic Specialists, Otolaryngologists (ENTs) and Rheumotologists.
Tier 1 (excellent):   100% after $15 per visit
Tier 2 (good):   100% after $25 per visit
Tier 3 (standard): 100% after $35 per visit

Out-of-State Specialist Office Visit: 100% after $25 per visit

Outpatient Mental Health and Substance Abuse Care
100% after $15 per visit

Inpatient Hospital Care – Medical (maximum four co-pays per person per calendar year; waived if readmitted within 30 days in the same calendar year)
100%, after $300 per admission

Outpatient Surgery (maximum four co-pays annually per person)
100% after $100 per occurrence

Emergency Room
100% after $50 co-pay per visit (waived if admitted)


Prescription Drug Co-payments
Retail up to 30-day supply:                    Mail Order up to 90-day supply:
Tier 1: $10                                                   Tier 1:   $20
Tier 2: $20                                                   Tier 2:   $40
Tier 3: $40                                                   Tier 3:   $90

Eligibility
Employees, retirees, survivors, and their eligible dependents without Medicare are eligible.  Members  must live in the plan’s service area.

Service Area
The Harvard Pilgrim Independence Plan is available in the following Massachusetts counties:
Barnstable, Berkshire, Bristol, Dukes, Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, Worcester

The Plan is also available in the following  states: Connecticut, Maine, New Hampshire, New York, Rhode Island, Vermont
Coverage may not be available in every city and town in these states. Contact the plan for more specific coverage information.
                     
Monthly Rates as of July 1, 2008

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

Harvard Pilgrim Health Care
1.800.542.1499