Available HMO Products

AETNA HEALTH INC.	TYPE:	FOR PROFIT:	NAIC #
400-1 Totten Pond Road Waltham, MA 02451 (800) 448-8752	IPA	Yes	95236

LARGE GROUP Closed Network HMO Certificate of Coverage	Form # HMO/MA COC-2 05/01 & Schedule of Benefits HMO/MA SOB-1 (10/03)
Dual Certificate HMO Certificate of Coverage (in-network) Aetna Health Ins. Co. Cert. (out-of-ntwk) Quality Point of Service Aetna Open Access Quality Point of Service	Form # HMO/MA COC-2 05/01 & Schedule of Benefits HMO/MA SOB-1 (10/03) AHIC/MA INSCT-2-A (07/01) & Schedule of Benefits CHI/MA SBQPOS-1 (10/01) & CHI/MA SBQPOS-2 (09/06) CHI/MA SBQPOS-1(10/03) & CHI/MA SBQPOS-2 (09/06)

Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc.	TYPE:	FOR PROFIT:	NAIC #
401 Park Drive, Landmark Center Boston, MA 02115-3326 (800) 262-BLUE ((800) 262-2583)	IPA and Staff;	No	12219

LARGE GROUP Closed Network Health Maintenance Organization Subscriber Certificate ²	Form # HMO BLUE (09-25-2010)
Dual Certificate Health Maintenance Organization Subscriber Certificate(in-network) Indemnity Plan Subscriber Certificate (out-of-network)	Form # HMO (09-25-2010) BCBS (10-1-2009)
Insured Preferred Provider Plan Preferred Blue PPO Preferred Provider Plan Subscriber Certificate	Form # HMO-PPO (09-25-2010)
SMALL GROUP/INDIVIDUAL Tel. Group Sales (800) 262-BLUE; Individual Sales (800) 422-3545 Closed network Health Maintenance Organization Subscriber Certificate ³	Form # HMO (09-25-2010)


Insured Preferred Provider Plan Preferred Blue PPO Preferred Provider Plan Subscriber Certificate	Form # HMO-PPO (09-25-2010)
MEDICARE Tel. (800) 678-2265
Medicare Advantage Medicare HMO Blue PlusRX Medicare HMO Blue PremierRX Medicare PPO Blue PlusRX Medicare PPO Blue PremierRX Blue Medicare PFFS PlusRx	Form # MED HMO PLUSRX (1-1-08) MED HMO PREMRX (1-1-08) MED PPO PLUSRX (1-1-08) MED PPO PREMRX(1-1-08) MED PFFS PLUSRX (1-1-08)
Medicare Wraparound Managed Blue for Seniors	Form # MBSR (1-1-06 Rev.)

BOSTON MEDICAL CENTER HEALTH PLAN, INC. ⁶	TYPE:	FOR PROFIT:	NAIC #
Two Copley Place, Suite 600 Boston, MA 02116 (877) 957-5300	Network	No	13203

SMALL GROUP/INDIVIDUAL
Tel. (877) 492-6967
Closed network

Employer Group Product:
Employer Choice Gold; Employer Choice Silver Plus; Employer Choice Silver Saver; Employer Choice Bronze Value; Employer Choice Bronze Plus; Employer Choice Bronze Saver

Commonwealth Choice Product: ⁵
Commonwealth Choice Gold; Commonwealth Choice Silver High; Commonwealth Choice Silver Low; Commonwealth Choice Bronze High; Commonwealth Choice Bronze Medium; Commonwealth Choice Bronze Low

BMCHP-EmpChoice2012ver.1

BMCHP-CChoice2012ver.1

CELTICARE HEALTH PLAN OF MASSACHUSETTS, INC. ⁶	TYPE:	FOR PROFIT:	NAIC #
380 Soldiers Field Road Boston, MA 02135 (866) 895-1786	Network	Yes

SMALL GROUP/INDIVIDUAL
Tel. (877) 264-6520
Closed network

Employer Group Product:
Celticare Premier; Celticare Solution; Celticare Solution 500; Celticare Solution 1000; Celticare Saver 250; Celticare Saver 2000; Celticare Saver HSA

Individual Insurance Plan Product:⁷
Celticare Premier; Celticare Solution; Celticare Solution 500; Celticare Solution 1000; Celticare Saver 250; Celticare Saver 2000; Celticare Saver HSA

Commonwealth Choice Product: ⁸
Gold; Silver High; Silver Medium; Silver Low; Bronze High; Bronze Medium & Bronze Low

CHP--GRP-EOC2010

CHP--IND-EOC2010

CHP-CC2010v1

CONNECTICARE OF MASSACHUSETTS, INC.	TYPE:	FOR PROFIT:	NAIC #
175 Scott Swamp Road Farmington, CT 06032 (800) 251-7722 / (860) 674-5700	IPA	Yes	95299

LARGE GROUP Closed Network HMO Open Access Plan HMO DEDUCTIBLE Open Access HMO Personal Care Plan	Form # CMI/HMO 01 (1/2010) CMI/HMO [Deductible] 01 (1/2010) CMI/HMOPCP 01 (1/2010)

Insured Preferred Provider Plan Point of Service Open Access Plan Large Group Deductible Option Point of Service Personal Care Plan	Form # CMI/POS 01 (1/2010) CMI/POS Deductible LG 01 (10/2011) CMI/POSPCP 01 (1/2010)
SMALL GROUP/INDIVIDUAL Tel. (800) 723-2986 Closed Network HMO Open Access Plan HMO DEDUCTIBLE Open Access	Form # CMI/HMO 01 (1/2010) CMI/HMO [Deductible] 01 (1/2010)

Insured Preferred Provider Plan CMI Point of Service Open Access Small Group Deductible Option	Form # CMI/POS 01 (1/2010) CMI/POS Deductible SG 01 (10/2011)

FALLON COMMUNITY HEALTH PLAN, INC.	TYPE:	FOR PROFIT:	NAIC #
10 Chestnut Street Worcester, MA 01608-2810 (800) 283-2556	Group	No	95541
*FALLON OFFERS HEALTH PLANS WITH TWO DIFFERENT PROVIDER NETWORKS. PLEASE CALL FALLON DIRECTLY IF YOU HAVE ANY QUESTIONS ABOUT WHETHER YOUR PROVIDER PARTICIPATES IN EACH NETWORK.*

LARGE GROUP Closed Network SELECT CARE NETWORK Select Care Select Care Choice DIRECT CARE NETWORK ⁹ Direct Care Direct Care	Form # 10-670-091 10-670-091 11-670-123 11-670-13
Dual Certificate SELECT CARE NETWORK Fallon Community Health Plan, Inc. Flex Care Select (in-network) Fallon Health & Life Assurance Co. (out-of-ntwk) DIRECT CARE NETWORK ⁹ Fallon Community Health Plan, Inc. Flex Care Direct (in-network) Fallon Health & Life Assurance Co.(out-of-ntwk)	Form # A05-670-148 Rev. 01 12/05 & A1573 Rev. 02/01/06 05-670-151 Rev. 01 12/05& A1573 Rev. 02/01/06

SMALL GROUP/INDIVIDUAL Tel. (800) 333-2535 x79097; (508) 799-2100 x79097 Closed Network SELECT CARE NETWORK ⁹ FCHP Select Care Premier I FCHP Select Care Premier II FCHP Select Care Premier Value FCHP Select Care Premium Saver I FCHP Select Care Premium Saver II FCHP Select Care Premium Saver Value I FCHP Select Care Premium Saver Value II FCHP Select Care Premium Saver Basic I FCHP Select Care Premium Saver Basic II FCHP Select Care Premium Saver 500 FCHP Select Care Premium Saver 1000 FCHP Select Care Premium Saver 1500 FCHP Select Care Premium Saver 2000 FCHP Select Care Premium Saver 2000 with $500 inpatient copayment FCHP Select Care Premium Saver 2000 with $500 inpatient copayment II FCHP Select Care Premium Saver 3000 with RX FCHP Select Care Choice 1250 FCHP Select Care Choice 1500 FCHP Select Care Choice 2000 FCHP Select Care Premium Saver 65/35 FCHP Select Care Premier Gold FCHP Select Care Rx Saver FCHP Select Care Premium Saver 500 CC FCHP Select Care Premium Saver 1000 Plus FCHP Select Care Rx Saver 250 FCHP Select Care Rx Saver 2000 FCHP Select Care Rx Saver Choice 2000	Form # 10-670-091
DIRECT CARE NETWORK ⁹ FCHP Direct Care Premier I FCHP Direct Care Premier II FCHP Direct Care Premier Value FCHP Direct Care Premium Saver I FCHP Direct Care Premium Saver II FCHP Direct Care Premium Saver Value I FCHP Direct Care Premium Saver Value II FCHP Direct Care Premium Saver Basic I FCHP Direct Care Premium Saver Basic II FCHP Direct Care Premium Saver 500 FCHP Direct Care Premium Saver 1000 FCHP Direct Care Premium Saver 1000 Classic FCHP Direct Care Premium Saver 1500 FCHP Direct Care Premium Saver 1500 Classic FCHP Direct Care Premium Saver 2000 with $500 inpatient copayment I FCHP Direct Care Premium Saver 2000 with $500 inpatient copayment II FCHP Direct Care Premium Saver 2000 Classic FCHP Direct Care Premium Saver 3000 w/ RX FCHP Direct Care Choice 1250 FCHP Direct Care Choice 2000 FCHP Direct Care Premium Saver 65/35 FCHP Direct Care Merit Choice Plan	Form # 11-670-123
FCHP TIERED CHOICE NETWORK ¹⁰ FCHP Tiered Choice $0 Deductible FCHP Tiered Choice $1000 Deductible FCHP Tiered Choice $0/$1000 Deductible FCHP Tiered Choice $0/$2000 Deductible	11-670-196
FCHP STEWARD COMMUNITY CARE NETWORK ¹¹ FCHP Steward Community Care FCHP Steward Community Care Premium Saver I FCHP Steward Community Care Premium Saver II FCHP Steward Community Care Premium Saver Value I FCHP Steward Community Care Premium Saver Basic I FCHP Steward Community Care Premium Saver Basic II FCHP Steward Community Care Premium Saver 65/35 FCHP Steward Community Care Premium Saver 500 FCHP Steward Community Care Premium Saver 1000 FCHP Steward Community Care Premium Saver 1000 Classic FCHP Steward Community Care Premium Saver 1500 FCHP Steward Community Care Premium Saver 1500 Classic FCHP Steward Community Care Premium Saver 2000 Classic FCHP Steward Community Care Premium Saver 2000 Classic w/500 copay I FCHP Steward Community Care Premium Saver 2000 Classic w/500 copay II FCHP Steward Community Care Premium Saver 3000 wRX FCHP Steward Community Care Choice 1250 FCHP Steward Community Care Choice 2000	11-670-389
MEDICARE Tel. (800) 868-5200 (ask for Senior Plan Office) Medicare Advantage Fallon Senior Plan: Saver Saver Basic RX Saver Enhanced RX Standard Standard Basic RX Standard Enhanced RX Plus Plus Basic RX Plus Enhanced RX Value Preferred Preferred Basic Preferred Enhanced RX	Form # 05-670-277 Rev. 00 12/05 CMS 2006-752 01/18/2006 05-670-278 Rev. 00 12/05 CMS 2006-755 01/17/2006 05-670-279 Rev. 00 12/05 CMS 2006-758 01/18/2006 05-670-280 Rev. 00 12/05 CMS 2006-750 01/18/2006 05-670-281 Rev. 00 12/05 CMS 2006-753 01/17/2006 05-670-282 Rev. 00 12/05 CMS 2006-756 01/18/2006 05-670-283 Rev. 00 12/05 CMS 2006-751 01/18/2006 05-670-284 Rev. 00-12/05 CMS 2006-754 01/17/2006 05-670-285 Rev. 00 12/05 CMS 2006-757 01/18/2006 05-670-286 Rev. 00 12/05 CMS 2006-xxx xx/xx/2006 05-670-287 Rev. 00 12/05 CMS 2006-759 01/17/2006 05-670-288 Rev. 00 12/05 CMS 2006-760 01/17/2006 05-670-289 Rev. 00 12/05 CMS 2006-761 01/17/2006

HARVARD PILGRIM HEALTH CARE, INC.	TYPE:	FOR PROFIT:	NAIC #
93 Worcester Street Wellesley, MA 02481-9181 (800) 338-4247	Group	No	96911

***HARVARD OFFERS HEALTH PLANS WITH TWO DIFFERENT PROVIDER NETWORKS. PLEASE CALL HARVARD DIRECTLY IF YOU HAVE ANY QUESTIONS ABOUT WHETHER YOUR PROVIDER PARTICIPATES IN EACH NETWORK.***

LARGE GROUP Closed Network Harvard Pilgrim HMO Benefit Handbook	Form # MAHMO2001 & Schedule of Benefits #114
Dual Certificate Harvard Pilgrim POS Plan Benefit Handbook (in-network) HPHC Insurance Company, Inc. Benefit Handbook (out-of-network)	Form # MAPOSi2001 & Schedule of Benefits #101 & MAPOSo2001 & Schedule of Benefits #102
Insured Preferred Provider Plan The Harvard Pilgrim PPO Benefit Handbook	Form # MAPPO0701 & Schedule of Benefits #100
THE HARVARD PILGRIM FOCUS NETWORK ¹⁰ The Harvard Pilgrim Focus Network℠ HMO Massachusetts Optional Schedule of Benefit Pages Value HMO 15 Affordable HMO 20 SOB Affordable HMO 25 SOB Best Buy HMO 500 SOB Best Buy HMO 1000 SOB Best Buy HMO 1500 SOB Best Buy HMO 2000 SOB	Form # 1268 & 1359 1269 & 1359
SMALL GROUP/INDIVIUDAL Tel. (800) 848-9995 Closed Network Value HMO 15 (Plan Name 05) Affordable HMO 20 (Plan Name W5) Affordable HMO 25 (Plan Name W6) Tiered Copayment HMO 20 (Plan Name 0C) Tiered Copayment HMO 30 (Plan Name 8-LC) Best Buy HMO 500 (Plan Name 19) Best Buy HMO 1000 Plan Name 0D) Best Buy HMO 1500 Plan Name 0D) Best Buy HMO 2000 (Plan Name 70) Core Coverage HMO (Plan Name 0H) Core Coverage 1750 HMO (Plan Name 6-LC) Gold 20 HMO (Plan Name RW-D) Silver 25 HMO (Plan Name RW-E) Silver 500 HMO (Plan Name RW-F) Silver 1000 HMO (Plan Name RW-G) Bronze 250 HMO (Plan Name RW-H) Bronze 250 HMO (Plan Name RW-I) Insured Preferred Provider Plan Value PPO 15 (Plan Name 07) Affordable PPO 20 (Plan Name V8) Affordable PPO 25 (Plan Name AQ) Best Buy PPO 500 (Plan Name 81) Best Buy PPO 1000 (Plan Name OE) Best Buy PPO 1500 (Plan Name LW-7) Best Buy PPO 2000 (Plan Name 84)	Form # 610/MAHMO2001; 113 610/MAHMO2001; 113 610/MAHMO2001; 113 610/MAHMO2001; 115 610/MAHMO2001; 115 610/MAHMO2001; 114 610/MAHMO2001; 114 610/MAHMO2001; 114 610/MAHMO2001; 591 610/MAHMO2001; 776 115 113 114 114 1000 1001 611/MAPPO0701; 100 611/MAPPO0701; 100 611/MAPPO0701; 100 611/MAPPO0701; MABBPPOSOB81 REV1 611/MAPPO0701; 592 974 611/MAPPO0701; MABBPPOSOB81 REV1
THE HARVARD PILGRIM FOCUS NETWORK ¹⁰ The Harvard Pilgrim Focus Network℠ HMO Massachusetts and The Harvard Pilgrim Focus Network℠ HMO for Individuals Massachusetts Optional Schedule of Benefit Pages Value HMO 15 Affordable HMO 20 SOB Affordable HMO 25 SOB Best Buy HMO 500 SOB Best Buy HMO 1000 SOB Best Buy HMO 1500 SOB Best Buy HMO 2000 SOB	Form # 1268 & 1359 1269 & 1359
Dual Certificate Premium POS 10 Harvard Pilgrim Benefit Handbook (in-network) HPHC Insurance Company, Inc. Benefit Handbook (out-of-network) Value POS 15 Harvard Pilgrim Benefit Handbook (in-network) HPHC Insurance Company, Inc. Benefit Handbook (out-of-network)	Form # MAPOSi2001 & Schedule of Benefits #101 & MAPOSo2001& Schedule of Benefits #102 MAPOSi2001& Schedule of Benefits #101 & MAPOSo2001 & Schedule of Benefits #102

MEDICARE Tel. (800) 848-9995 Medicare Advantage First Seniority Freedom First Seniority Freedom Plus	Form # H7226 CMS 2008 085 11/9/07 H7226 CMS 2008_083 11/9/07

HEALTH NEW ENGLAND, INC.	TYPE:	FOR PROFIT:	NAIC #
One Monarch Place Springfield, MA 01144 (800) 842-4464	IPA	Yes	95673

***HEALTH NEW ENGLAND OFFERS HEALTH PLANS WITH TWO DIFFERENT PROVIDER NETWORKS. PLEASE CALL HEALTH NEW ENGLAND DIRECTLY IF YOU HAVE ANY QUESTIONS ABOUT WHETHER YOUR PROVIDER PARTICIPATES IN EACH NETWORK.*** ¹¹

LARGE GROUP Closed Network HNE Health Max HNE Health Plus HNE Principle HNE Complete Max HNE Complete HNE Complete Plus HNE Choice Plus HNE Choice HNE Focus HNE Essential Max HNE Essential Plus HNE Wise Max HNE Wise Plus	Form # HNE/HMO-06 HNE/HMO-06 HNE/HMO-06 HNE/HMO-06 HNE/HMO-06 HNE/HMO-06 HNE/HMO-06 HNE/HMO-06 HNE/HMO-06 HNEHMOwithDED-06 HNEHMOwithDED-06 HNEHMOwithHIGHDED-06 HNEHMOwithHIGHDED-06

Insured Preferred Provider Plan HNE Premier PPO HNE Advantage Plus HNE PPO Saver HNE Wise PPO	Form # HNE/PHCS-PPO-06 HNE/POSPLUS-06 HNE/PHCS-PPOSaver-06 HNE/PHCS-PPOSaver-06
SMALL GROUP/INDIVIDUAL Tel. (800) 842-4464 Closed Network HEALTH NEW ENGLAND NETWORK (STANDARD NETWORK) HNE Health Max HNE Health Plus HNE Principle HNE Complete Max HNE Complete HNE Complete Plus HNE Choice Plus HNE Choice HNE Focus HNE Essential Max HNE Essential Plus HNE Wise Max HNE Wise Plus	Form # HNE/HMO-06 HNE/HMO-06 HNE/HMO-06 HNE/HMO-06 HNE/HMO-06 HNE/HMO-06 HNE/HMO-06 HNE/HMO-06 HNE/HMO-06 HNEHMOwithDED-06 HNEHMOwithDED-06 HNEHMOwithHIGHDED-06 HNEHMOwithHIGHDED-06

HNE ALLIANCE NETWORK ¹² HNE Principle Alliance	HNE/HMO-06
Insured Preferred Provider Plan HNE Advantage Plus - High Option HNE Advantage Plus - Mid Option HNE Advantage Plus - Low Option HNE Premier PPO - Premium Plan HNE Premier PPO - Value Plan HNE Premier PPO - Basic Plan HNE Premier PPO - Mid Option HNE Premier PPO - Low Option HNE Wise PPO	Form # HNE/POSPLUS-06 HNE/POSPLUS-06 HNE/POSPLUS-06 HNE/PHCS-PPO-06 HNE/PHCS-PPO-06 HNE/PHCS-PPO-06 HNE/PHCS-PPO-06 HNE/PHCS-PPO-06 HNE/PHCS-PPOSaver-06
MEDICARE Tel. (800) 842-4464
Medicare Wraparound HNE MedPlus PPO	Form # HNE/PHCS/PPO-07-Medicare-Grp

NEIGHBORHOOD HEALTH PLAN INC.	TYPE:	FOR PROFIT:	NAIC #
253 Summer Street Boston, MA 02210 (800) 433-5556	Group	No	11109

***NEIGHBORHOOD HEALTH PLAN OFFERS HEALTH PLANS WITH TWO DIFFERENT PROVIDER NETWORKS. PLEASE CALL NEIGHBORHOOD HEALTH PLAN DIRECTLY IF YOU HAVE ANY QUESTIONS ABOUT WHETHER YOUR PROVIDER PARTICIPATES IN EACH NETWORK.***

LARGE GROUP Closed Network NHP Business Choice Plan NHP Care HMO for GIC	Form # BPEOC-04-2.0 NHPGICEC-08-1.0

SMALL GROUP/INDIVIDUAL Tel. Group Sales (617) 772-5663; Individual Sales (800) 462-5449 Closed Network NEIGHBORHOOD HEALTH PLAN NETWORK (STANDARD NETWORK)	Form #

NETWORK HEALTH, LLC ¹⁴	TYPE:	FOR PROFIT:	NAIC #
101 Station Landing Medford, MA 02155	Network	No	67369

TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION, INC. (d/b/a Tufts Health Plan)	TYPE:	FOR PROFIT:	NAIC #
(d/b/a Tufts Health Plan) 705 Mount Auburn Street Watertown, MA 02472-1508	IPA & Group	No	95688

***TUFTS OFFERS HEALTH PLANS WITH TWO DIFFERENT PROVIDER NETWORKS. PLEASE CALL TUFTS DIRECTLY IF YOU HAVE ANY QUESTIONS ABOUT WHETHER YOUR PROVIDER PARTICIPATES IN EACH NETWORK.***

LARGE GROUP Closed Network HMO Premium Benefit Plan Evidence of Coverage HMO Value Benefit Plan Evidence of Coverage HMO Basic Benefit Plan Evidence of Coverage	Form # EC-MASSHMO-001 Ed. 1-2007 EC-MASSHMO-002 Ed. 1-2007 EC-MASSHMO-003 Ed. 1-2007

Insured Preferred Provider Plan Preferred Provider Option Certificate of Insurance Point of Service Option Certificate of Coverage	Form # MA-PPO-001 Ed. 1-2007 CC-MAPOS-001 Ed. 1-2007
SMALL GROUP Tel. Group Sales (800)208-8013; Individual Sales (800)957-6596 Closed Network TUFTS ASSOCIATED HEALTH MAINTENANCE ORGAIZATION NETWORK (STANDARD NETWORK) HMO Premium Benefit Plan HMO Value Plan HMO Select 20 Options HMO Basic Plan TUFTS HEALTH PLAN SELECT NETWORK ¹⁵ HMO Premium Plan HMO Select 10 Option HMO Value Plan Advanatage HMO Select 750 Option HMO Basic Plan Advanatge HMO Select 2000 Option	Form # EC-MASSHMO-001 Ed. 1-2009 EC-MASSHMO-002 Ed. 1-2009 EC-MASSHMO-003 Ed. 1-2009 EC-MASSHMO-001 Ed. 1-2009 EC-MASSHMO-002 Ed. 1-2009 EC-MASSHMO-003 Ed. 1-2009

Insured Preferred Provider Plan Preferred Provider Option Certificate of Insurance Point of Service Option Certificate of Coverage	Form # MA-PPO-001 Ed. 1-2009 CC-MAPOS-001 Ed. 1-2009

MEDICARE Tel. (800) 246-2400 Medicare Advantage Medicare Preferred	Form # SHMAINDY2KF85M
Medicare Wraparound Tufts Medicare Complement (TMC) ¹⁶	Form # H2256-2008-39R1 7-10-2008

UNITEDHEALTHCARE OF NEW ENGLAND, INC. ¹⁷	TYPE:	FOR PROFIT:	NAIC #
475 Kilvert Street, Suite 310 Warwick, RI 02886-1392 (800) 447-1245	IPA	Yes	95149

¹ On or after July 1, 2007, all small group health benefit plans offered by carriers are available to any Massachusetts eligible individual [as defined in M.G.L. c. 176J 1].
² This plan is available both with and without prescription drug coverage.
³ This plan is available with prescription drug coverage only.
⁴ Please call the carrier directly if you have any questions about whether the BMC HealthNet Plan Select Network is specifically available in your area and whether your primary care provider, specialist or acute care facility participates in the network.
⁵ This form is to be offered to individuals and eligible small groups through the Massachusetts Health Connector (“Connector”) but the benefit structure is exactly the same as what is offered to eligible small groups outside of the Connector.
⁶ Please call the carrier directly if you have any questions about whether the CeltiCare Direct Network is specifically available in your area and whether your primary care provider, specialist or acute care facility participates in the Direct Care Network.
⁷ This form is to be offered to individuals only for administrative ease but the benefit structure is exactly the same as what is offered to eligible small groups.
⁸ This form is to be offered to individuals and groups through the Massachusetts Health Connector ("Connector) only for administrative ease but the benefit structure is exactly the same as what is offered to eligible small groups and eligible individual outside of the Connector.
⁹ The Direct Care Network is different than the Select Care Network. Please call the carrier directly if you have any questions about whether the Direct Care Network is specifically available in your area and whether your primary care provider, specialist or acute care facility participates in the Direct Care Network

¹⁰ The Harvard Pilgrim Focus Network is different than the HMO primary care provider network. Please call the carrier directly if you have any questions about whether the Harvard Pilgrim Focus Network is specifically available in your area and whether your primary care provider participates within the Harvard Pilgrim Focus network.
¹¹ Carrier notified the Division that it intends to discontinue offering the HNE Alliance Network as of November 1, 2011 and nonrenewing enrollees beginning February 1, 2012.
¹² The HNE Alliance Network is different than the HMO primary care provider network. Please call the carrier directly if you have any questions about whether the HNE Alliance Network is specifically available in your area and whether your primary care provider participates within the HNE Alliance network.
¹³The NHP Select Network is different than the HMO primary care provider network. Please call the carrier directly if you have any questions about whether the NHP Select Network is specifically available in your area and whether your primary care provider participates within the NHP Select Network
¹⁴ At this time Network Health, LLC only offers a Commonwealth Care Health Insurance Program (Commonwealth Care). Commonwealth Care is an insurance program for uninsured individuals with incomes that fall within certain guidelines and who meet other qualifications. Commonwealth Care is run by the Massachusetts Health Connector (“The Connector”). Questions about Commonwealth Care should be directed to the Commonwealth Care Customer Service Center at 1-877-MA-ENROLL or 1-877-623-6765. Persons who are deaf or hard of hearing should call TTY at 1-800-623-7773.
¹⁵ The Tufts Health Plan Select Network is different than the Tufts Associated Health Maintenance Organization Network. Please call the carrier directly if you have any questions about whether the Tufts Health Plan Select Network is specifically available in your area and whether your primary care provider, specialist or acute care facility participates within the Tufts Health Plan Select Network
¹⁶ An HMO product that provides supplemental coverage for the costs of HMO-provided services not reimbursed by Medicare. The plan is offered to employer groups
¹⁷UnitedHealthcare of New England, Inc. notified the Division of Insurance on June 2, 2011 that it intends to discontinue and nonrenew all of its health insurance business in Massachusetts and eventually withdraw its license to operate as a Massachusetts Health Maintenance Organization

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