October 24, 2000
FOR IMMEDIATE RELEASE
CONTACT: CHRISTOPHER GOETCHEUS
(617) 521-7333


STATE CONSUMER AFFAIRS DIRECTOR URGES PARTNERS/TUFTS MEMBERS TO UNDERSTAND THEIR OPTIONS


(BOSTON, MA) The impasse in contract discussions between Partners HealthCare Systems, Inc. (Partners) and Tufts Health Plan (Tufts) today prompted Massachusetts Consumer Affairs and Business Regulation Director Jennifer Davis Carey to call on employers to carefully weigh their options on behalf of their employees.

"Most immediately, there is one group of consumers who need to make a personal decision about whether or not they will continue with Tufts within the next week. Those are people who buy nongroup health coverage and whose primary care physicians are affiliated with Partners," said Director Carey.

The Consumer Affairs Office and the Division of Insurance offer the following information, which will be updated on a regular basis:

Current Non-Group Members

  • The open enrollment period for nongroup ends October 31, 2000. The decision you are making will be for the period December 1, 2000 through November 30, 2001.
  • If you stay with Tufts and you currently use Partners doctors and hospitals, at present you must assume that you will have to change to another primary care provider (PCP) and hospital system before April 1, 2001. There are a few exceptions. See "Continuity of Care" below.
  • If you aren't sure if your PCP will not be a part of Tufts because of the impasse in contract negotiations between Tufts and Partners, call him or her.
What should I do "now"?
  • Except for non-group members and those who have made arrangements to join Tufts effective December 1, 2000 as nongroup members, no one needs to make any hard and fast decisions at this time. Employers who might want to offer an optional open enrollment to other HMOs and/or insurers in 2001 should the Partners/Tufts contractual matter not be resolved before the end of March, 2001, should contact those insurers now to make sure that they will have their cooperation.
Employers Who Offer Only Tufts HMO, PPO and/or POS Products to Their Employees and Are Not Self-Insured.
  • The first step is to call your account manager and find out if any of your employees currently have PCPs who are potentially affected because of their affiliation with Partners. Your affected employees should receive letters directly from Tufts, but this way you will have an idea as to the percentage of your employees for whom you must plan. (Depending on where the employees live, there may be limited options within the Tufts network; i.e. the North Shore.)
  • You can then decide if you want to look into offering another insurer. You don't need to act immediately. You can change carriers in 2001 if the Partners/Tufts contract dispute is not resolved. You need not do anything now, but you should make contingency plans.
See the "Continuity of Care" information section below. It applies to those in HMO products, only.

Employers Who Offer More than One Plan
  • You need not do anything now. You can call your account manager and learn how many of your employees may be affected.
  • You can decide to hold another open enrollment for those whose providers are terminating from Tufts later in 2001 if the contract dispute does not get resolved. You will need to ask your other providers if they will accept only those in the Tufts Plan who are "stranded" at that time, or require a complete open enrollment. At the moment, the date when Partners facilities will not be available is April 1, 2001.
  • Because of the media interest, most of your employees who are currently in Tufts and/or are considering moving to Tufts will be aware of the potential loss of Partners providers in April. However, we suggest that you make sure that you communicate this to your employees so that there is no misunderstanding----especially if you don't plan on having a special open enrollment later on if the Partners/Tufts contract dispute is not resolved.
See the "Continuity of Care" information section below. It applies to those in HMO products, only.

Employers Who Are Self-Insured and use Tufts as an ASO
  • Call your account manager because the actual contractual arrangement you have must be considered.
Secure Horizons
  • Whether you have Secure Horizons as an individual or through an employer or retiree group, this contractual dispute does not affect you.
Continuity of Care - HMO Members Only
  • If you are an HMO member in active treatment on March 31, 2001 with a provider who is terminating his or her contract as of March 31, 2001, you will be covered through the current treatment or up to 90 days, whichever is shorter. For example, if you happen to be treating for diabetes on March 31, you could continue to see the same provider for up to 90 days.
  • Another example, for those who become/are pregnant. If you began pre-natal care before March 31, 2001 and are still treating on March 31, 2001, you will be allowed continued access to the terminating practitioner through the post-partum period, (which is defined by Tufts as 6 weeks post delivery). Tufts says this includes access to a Partners hospital for the delivery.
  • If the new infant cannot be released at the same time as the mother because of medical problems on or after March 31, 2001, Tufts will continue coverage for up to 90 days. Any condition that still requires hospitalization will be handled individually by Tufts.
Useful Phone Numbers

Tufts Nongroup members: Customer Relations (800) 462-0024
Tufts Small Employer Groups: Call your intermediary, if you have one.
Massachusetts Business Association: (800) 696-8167
Northeast Business Trust: (800) 464-0039
Small Business Service Bureau: (800) 472-7199
North Central Massachusetts Chamber of Commerce: (978) 840-4300
If you don't use an intermediary, contact your Account Manager at Tufts.

All Other Tufts Employer Groups: Contact your Account Manager.

Tufts Secure Horizons members: (800) 701-9000

Tufts Sales Department can be reached at (781) 466-1070 and (800) 442-0422.

NOTE: Tufts is developing a web site where one can see if his/her physician is affiliated with Partners. The site is expected to be ready before October 27, 2000.

Office of Consumer Affairs and Business Regulation Consumer Hotline: (888) 283-3757

Massachusetts Division of Insurance Consumer Services: (617) 521-7777

Attorney General's Office: 1-888-830-MASS(6277)