GIC Health Plan Options

Navigator by Tufts Health Plan
Eligibility
Plan Contact Information
Plan Service Area

Plan Overview
The Navigator Plan, administered by Tufts Health Plan, 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 and Tier 2 physicians.  Contact the plan to see if your provider is in the network and how he/she is rated.  Members pay a lower inpatient hospital co-pay when they use Tier 1 hospitals.  Contact the plan to see which tier your hospital is in.

The mental health benefits of this plan, administered by United Behavioral Health (UBH), offer you a choice of using network providers and paying a co-payment, or seeking care from out-of-network providers at higher out-of-pocket costs.


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
Tufts Health Plan  tiers the following Massachusetts specialists based on quality and cost-efficiency standards: Cardiologists, Dermatologists, Endocrinologists, Gastroenterologists, General Surgeons, Neurologists, Obstetrician/Gynecologists, Ophthalmologists, Orthopedic Specialists, Otolaryngologists (ENTs), Rheumotologists, and Urologists.
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 (contact UBH for other mental health and substance abuse benefit details)
100% after $15 per visit
UBH also offers EAP services.

Inpatient Hospital Care – Medical (maximum four co-pays per person per calendar year; waived if readmitted within 30 days in the same calendar year)
Tufts Health Plan tiers its hospitals for  adult medical/surgical services, obstetrics (OB), and pediatrics based on quality and cost-effectiveness.
Tier 1:   100% after $200 per admission
Tier 2: 100% after $400 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
Navigator by Tufts Health Plan is available in the following Massachusetts counties:
Barnstable, Berkshire, Bristol, Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, Worcester

The Plan is also available in the following  states: Connecticut, 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.

Medical Benefits:
Tufts Health Plan
1.800.870.9488

Mental Health, Substance Abuse and EAP Benefits:
United Behavioral Health (access code: 10910)
1.888.610.9039