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Barnstable County Preferred Provider Plan Medical Service

MEDICAL
Insured Preferred Provider Plans		 Product Name Form Number
Aetna Life Insurance Company 1 Student Sports Accident Insurance GR-96449 1005 ED. 01-10 et al.
BCBSMA HMO Blue, Inc. Preferred Blue PPO Options HMO-PPO (1-1-2013)
BCBSMA HMO Blue, Inc. Preferred Blue PPO with Hospital Choice HMO-PPO (1-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue Care Elect BCBS-PPO (1-1-2013)
CIGNA Health and Life Insurance Company Point of Service HC-CER1, et al.
CIGNA Health and Life Insurance Company Point of Service Open Access HC-CER1, et al.
CIGNA Health and Life Insurance Company CareLink/Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company PPO HC-CER1, et al.
CIGNA Health and Life Insurance Company Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company Medical LocalPlus HC-CER1, et al.
4 Ever Life Insurance Company GeoBlue Expat/Global ExPat 54.1315 (MA)
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Fallon Health & Life Assurance Company Fallon Preferred Care 11-670-345 Rev. 00 12/11
Harvard Pilgrim Health Care, Inc. Standard PPO  1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Affordable PPO 25-Flex 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy HSA PPO 1829_04/1824_04;SOB 1826_03
HPHC Insurance Company, Inc. The PPO Plan Massachusetts MAG1PPOHBREV
HPHC Insurance Company, Inc. Best Buy HSA PPO 310
HPHC Insurance Company, Inc. HPHC Qualifying Student Health Plan HPHC 06-BR-MA-PPO
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/First Health
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Multiplan, Inc.
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Cigna PPO
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW PHCS 101 10/26/04
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CERT 101 5/19/03
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CIGNA 101
Neighborhood Health Plan, Inc. NHP PPO Prime  NHPPPOv4
Neighborhood Health Plan, Inc. NHP PPO Prime (Small Group) PPOMMv1
Tufts Associated Health Maintenance Organization, Inc. Point of Service Option CC-MAPOS-001 Ed. 1-2017
 
Tufts Associated Health Maintenance Organization, Inc. Preferred Provider Option MA-PPO-001 Ed. 1-2017
 
Tufts Associated Health Maintenance Organization, Inc. PPO Basic Platinum MA-PPO-001 Ed. 1-2018
Tufts Associated Health Maintenance Organization, Inc. PPO Value Platinum MA-PPO-001 Ed. 1-2018
Tufts Insurance Company Advantage PPO MA-TICOPPO-001  Ed.1-2012
 
Tufts Insurance Company CareLink
 		 MA-TICOPPO-002 Ed. 1-2012
 
Tufts Insurance Company Student Health PPO MA-TICOPPO-003
Tufts Insurance Company Sports Accident PPO MA-TICPPO-SPACC-001 Ed. 1-2015
United HealthCare Insurance Company  Choice Plus (Large Group) COC.INS.2018.LG.MA & SBN.CHP.I.2018.LG.MA
United HealthCare Insurance Company  Choice Plus (Small Group) COC.INS.2018.SG.MA & SBN.CHC.I.2018.SG.MA
United HealthCare Insurance Company Options PPO  COC.INS.2018.LG.MA & SBN.OPT.I.2018.LG.MA
United HealthCare Insurance Company Transplant Benefit Certificate UCC-CERT-MA (02/04)
United HealthCare Insurance Company Options PPO Non-Differential COC.INS.2018.LG.MA & SBN.NDF.I.2018.LG.MA
United HealthCare Insurance Company Blanket Student PPO Injury & Sickness Benefits Group Policy COL-17-MA CERT


 

1 Form GR-96449 1005 ED. 01-10 et al to replace the originally filed form GR-96487-1 ED. 10-07 et al upon group's renewal date.

* Unicare Life and Health Insurance Company (Form #s BCR 100.1 MA 10/04 and BCR 105.1-MA 11/04). does not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts.

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Berkshire County Preferred Provider Plan Medical Service

MEDICAL
Insured Preferred Provider Plans		 Product Name Form Number
Aetna Life Insurance Company 1 Student Sports Accident Insurance GR-96449 1005 ED. 01-10 et al.
BCBSMA HMO Blue, Inc. Preferred Blue PPO Options HMO-PPO (1-1-2013)
BCBSMA HMO Blue, Inc. Preferred Blue PPO with Hospital Choice HMO-PPO (1-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue Care Elect BCBS-PPO (1-1-2013)
CIGNA Health and Life Insurance Company Point of Service HC-CER1, et al.
CIGNA Health and Life Insurance Company Point of Service Open Access HC-CER1, et al.
CIGNA Health and Life Insurance Company CareLink/Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company PPO HC-CER1, et al.
CIGNA Health and Life Insurance Company Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company Medical LocalPlus HC-CER1, et al.
ConnectiCare of Massachusetts, Inc. Point of Service Open Access CMI/POS OA/BS 01 (01/2017)
ConnectiCare of Massachusetts, Inc. Large Group Deductible  CMI/POS OA/BS 01 (01/2017)
ConnectiCare of Massachusetts, Inc. Chopice Mass POS Copay $40 CMI/POS OA/BS 01 (01/2018)
4 Ever Life Insurance Company GeoBlue Expat/Global ExPat 54.1315 (MA)
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Harvard Pilgrim Health Care, Inc. Standard PPO  1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Affordable PPO 25-Flex 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy HSA PPO 1829_04/1824_04;SOB 1826_03
Health New England, Inc. HNE Advantage Plus HNE/POSPLUS-06
Health New England, Inc. HNE Premier PPO HNE/PHCS-PPO-06
Health New England, Inc. HNE PPO Saver HNE/PHCS-PPOSaver-06
Health New England, Inc. HNE Wise PPO HNE/PHCS-PPOSaver-06
Health New England, Inc. HNE MedPlus PPO HNE/PHCS/PPO-07-Medicare-Grp
Health New England, Inc. HNE PPO Essential HNE-PPO-06 HNE/PHCS-PPO-06
HPHC Insurance Company, Inc. The PPO Plan Massachusetts MAG1PPOHBREV
HPHC Insurance Company, Inc. Best Buy HSA PPO 310
HPHC Insurance Company, Inc. HPHC Qualifying Student Health Plan HPHC 06-BR-MA-PPO
HPHC Insurance Company, Inc. Hospital PreferSM Best Buy PPO 1456 (Grp)/1459 (Ind) & SOB1455
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/First Health
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Multiplan, Inc.
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Cigna PPO
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW PHCS 101 10/26/04
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CERT 101 5/19/03
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CIGNA 101
Neighborhood Health Plan, Inc. NHP PPO Prime  NHPPPOv4
Neighborhood Health Plan, Inc. NHP PPO Prime (Small Group) PPOMMv1
Tufts Associated Health Maintenance Organization, Inc. Point of Service Option CC-MAPOS-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc. Preferred Provider Option MA-PPO-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc. PPO Basic Platinum MA-PPO-001 Ed. 1-2018
Tufts Associated Health Maintenance Organization, Inc. PPO Value Platinum MA-PPO-001 Ed. 1-2018
Tufts Insurance Company Advantage PPO MA-TICOPPO-001 Ed.1-2012
Tufts Insurance Company CareLink
 		 MA-TICOPPO-002 Ed. 1-2012
 
Tufts Insurance Company Student Health PPO MA-TICOPPO-003
Tufts Insurance Company Sports Accident PPO MA-TICPPO-SPACC-001 Ed. 1-2015
United HealthCare Insurance Company Options PPO  COC.INS.2018.LG.MA & SBN.OPT.I.2018.LG.MA
United HealthCare Insurance Company Transplant Benefit Certificate UCC-CERT-MA (02/04)
United HealthCare Insurance Company Options PPO Non-Differential COC.INS.2018.LG.MA & SBN.NDF.I.2018.LG.MA
United HealthCare Insurance Company Blanket Student PPO Injury & Sickness Benefits Group Policy COL-17-MA CERT
United HealthCare Insurance Company Choice Plus (Large Group) COC.INS.2018.LG.MA & SBN.CHP.I.2018.LG.MA
United HealthCare Insurance Company Choice Plus (Small Group) COC.INS.2018.SG.MA & SBN.CHC.I.2018.SG.MA


1  Form GR-96449 1005 ED. 01-10 et al to replace the originally filed form GR-96487-1 ED. 10-07 et al upon group's renewal date.

*  Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - Unicare Life and Health Insurance Company (Form #s BCR 100.1 MA 10/04 and BCR 105.1-MA 11/04) and United HealthCare Insurance Company (Form# CPCEMA497).

 

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Bristol County Preferred Provider Plan Medical Service

MEDICAL
Insured Preferred Provider Plans		 Product Name Form Number
Aetna Life Insurance Company Open Choice GR-9
Aetna Life Insurance Company Managed Choice GR-9
Aetna Life Insurance Company Student Blanket Policy GR96134
Aetna Life Insurance Company 1 Student Sports Accident Insurance GR-96449 1005 ED. 01-10 et al.
Aetna Life Insurance Company 2 Savings Plus GR-9 et al.
BCBSMA HMO Blue, Inc. Preferred Blue PPO Options HMO-PPO (1-1-2013)
BCBSMA HMO Blue, Inc. Preferred Blue PPO with Hospital Choice HMO-PPO (1-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue Care Elect BCBS-PPO (1-1-2013)
CIGNA Health and Life Insurance Company Point of Service HC-CER1, et al.
CIGNA Health and Life Insurance Company Point of Service Open Access HC-CER1, et al.
CIGNA Health and Life Insurance Company CareLink/Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company PPO HC-CER1, et al.
CIGNA Health and Life Insurance Company Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company Medical LocalPlus HC-CER1, et al.
4 Ever Life Insurance Company GeoBlue Expat/Global ExPat
54.1315 (MA)
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Harvard Pilgrim Health Care, Inc. Standard PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Affordable PPO 25-Flex 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy HSA PPO 1829_04/1824_04;SOB 1826_03
HPHC Insurance Company, Inc. The PPO Plan Massachusetts MAG1PPOHBREV
HPHC Insurance Company, Inc. Best Buy HSA PPO 310
HPHC Insurance Company, Inc. HPHC Qualifying Student Health Plan HPHC 06-BR-MA-PPO
HPHC Insurance Company, Inc. Hospital PreferSM Best Buy PPO 1456 (Grp)/1459 (Ind) & SOB1455
Minuteman Health, Inc.3 MyDoc PPO National MHI-NatlPPO-EOC CLEAN-8112015
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/First Health
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Multiplan, Inc.
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Cigna PPO
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW PHCS 101 10/26/04
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CERT 101 5/19/03
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CIGNA 101
Neighborhood Health Plan, Inc. NHP PPO Prime NHPPPOv4
Neighborhood Health Plan, Inc. NHP PPO Prime (Small Group) PPOMMv1
Tufts Associated Health Maintenance Organization, Inc. Point of Service Option CC-MAPOS-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc. Preferred Provider Option MA-PPO-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc. PPO Basic Platinum MA-PPO-001 Ed. 1-2018
Tufts Associated Health Maintenance Organization, Inc. PPO Value Platinum MA-PPO-001 Ed. 1-2018
Tufts Insurance Company Advantage PPO MA-TICOPPO-001 Ed.1-2012
Tufts Insurance Company CareLink
 		 MA-TICOPPO-002 Ed. 1-2012
 
Tufts Insurance Company Student Health PPO MA-TICOPPO-003
Tufts Insurance Company Sports Accident PPO MA-TICPPO-SPACC-001 Ed. 1-2015
United HealthCare Insurance Company  Choice Plus (Large Group) COC.INS.2018.LG.MA & SBN.CHP.I.2018.LG.MA
United HealthCare Insurance Company  Choice Plus (Small Group) COC.INS.2018.SG.MA & SBN.CHC.I.2018.SG.MA
United HealthCare Insurance Company Options PPO  COC.INS.2018.LG.MA & SBN.OPT.I.2018.LG.MA
United HealthCare Insurance Company Transplant Benefit Certificate UCC-CERT-MA (02/04)
United HealthCare Insurance Company Options PPO Non-Differential COC.INS.2018.LG.MA & SBN.NDF.I.2018.LG.MA
United HealthCare Insurance Company Blanket Student PPO Injury & Sickness Benefits Group Policy COL-17-MA CERT


1 Form GR-96449 1005 ED. 01-10 et al to replace the originally filed form GR-96487-1 ED. 10-07 et al upon group's renewal date.
2 The "Savings Plus" Network tiers acute care hospitals & specialists.
3 Plan in-network coverage includes (1) providers who contract directly with MHI and (2) providers in the First Health Network when services are received OUTSIDE of the 7 counties in MHI’s Service Area.

*  Unicare Life and Health Insurance Company (Form #s BCR 100.1 MA 10/04 and BCR 105.1-MA 11/04). does not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts.

 

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Dukes County Preferred Provider Plan Medical Service

MEDICAL
Insured Preferred Provider Plans		 Product Name Form Number
Aetna Life Insurance Company Student Sports Accident Insurance GR-96487-1 ED. 10-07 et al.
BCBSMA HMO Blue, Inc. Preferred Blue PPO Options HMO-PPO (1-1-2013)
BCBSMA HMO Blue, Inc. Preferred Blue PPO with Hospital Choice HMO-PPO (1-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue Care Elect BCBS-PPO (1-1-2013)
CIGNA Health and Life Insurance Company Point of Service HC-CER1, et al.
CIGNA Health and Life Insurance Company Point of Service Open Access HC-CER1, et al.
CIGNA Health and Life Insurance Company CareLink/Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company PPO HC-CER1, et al.
CIGNA Health and Life Insurance Company Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company Medical LocalPlus HC-CER1, et al.
4 Ever Life Insurance Company GeoBlue Expat/Global ExPat 54.1315 (MA)
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Harvard Pilgrim Health Care, Inc. Standard PPO  1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Affordable PPO 25-Flex 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy HSA PPO 1829_04/1824_04;SOB 1826_03
HPHC Insurance Company, Inc. The PPO Plan Massachusetts MAG1PPOHBREV
HPHC Insurance Company, Inc. Best Buy HSA PPO 310
HPHC Insurance Company, Inc. HPHC Qualifying Student Health Plan HPHC 06-BR-MA-PPO
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/First Health
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Multiplan, Inc.
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Cigna PPO
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW PHCS 101 10/26/04
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CERT 101 5/19/03
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CIGNA 101
Neighborhood Health Plan, Inc. NHP PPO Prime NHPPPOv4
Neighborhood Health Plan, Inc. NHP PPO Prime (Small Group) PPOMMv1
Tufts Associated Health Maintenance Organization, Inc.  Point of Service Option CC-MAPOS-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc.  Preferred Provider Option MA-PPO-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc. PPO Basic Platinum MA-PPO-001 Ed. 1-2018
Tufts Associated Health Maintenance Organization, Inc. PPO Value Platinum MA-PPO-001 Ed. 1-2018
Tufts Insurance Company Advantage PPO MA-TICOPPO-002 Ed. 1-2012
Tufts Insurance Company CareLink MA-TICOPPO-001 Ed.1-2012
Tufts Insurance Company Student Health PPO MA-TICOPPO-003
Tufts Insurance Company Sports Accident PPO MA-TICPPO-SPACC-001 Ed. 1-2015
United HealthCare Insurance Company Transplant Benefit Certificate UCC-CERT-MA (02/04)
United HealthCare Insurance Company Options PPO Non-Differential COC.INS.2018.LG.MA & SBN.NDF.I.2018.LG.MA
United HealthCare Insurance Company Choice Plus (Large Group) COC.INS.2018.LG.MA & SBN.CHP.I.2018.LG.MA
United HealthCare Insurance Company Choice Plus (Small Group) COC.INS.2018.SG.MA & SBN.CHC.I.2018.SG.MA

*  Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - Unicare Life and Health Insurance Company (Form #s BCR 100.1 MA 10/04 and BCR 105.1-MA 11/04) and United HealthCare Insurance Company (Form# CPCEMA497).

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Essex County Preferred Provider Plan Medical Service

MEDICAL
Insured Preferred Provider Plans		 Product Name Form Number
Aetna Life Insurance Company Open Choice GR-9
Aetna Life Insurance Company Managed Choice GR-9
Aetna Life Insurance Company Student Blanket Policy GR96134
Aetna Life Insurance Company 1 Student Sports Accident Insurance GR-96449 1005 ED. 01-10 et al.
Aetna Life Insurance Company 2 Savings Plus GR-9 et al.
Blue Cross and Blue Shield of Massachusetts, Inc. Blue Care Elect BCBS-PPO (1-1-2013)
BCBSMA HMO Blue, Inc.
 		 Preferred Blue PPO Options
 		 HMO-PPO (1-1-2013)
 
BCBSMA HMO Blue, Inc. Preferred Blue PPO with Hospital Choice HMO-PPO (1-1-2013)
CIGNA Health and Life Insurance Company Point of Service HC-CER1, et al.
CIGNA Health and Life Insurance Company Point of Service Open Access HC-CER1, et al.
CIGNA Health and Life Insurance Company CareLink/Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company PPO HC-CER1, et al.
CIGNA Health and Life Insurance Company Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company Medical LocalPlus HC-CER1, et al.
4 Ever Life Insurance Company GeoBlue Expat/Global ExPat 54.1315 (MA)
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Harvard Pilgrim Health Care, Inc. Standard PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Affordable PPO 25-Flex 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy HSA PPO 1829_04/1824_04;SOB 1826_03
HPHC Insurance Company, Inc. The PPO Plan Massachusetts MAG1PPOHBREV
HPHC Insurance Company, Inc. Best Buy HSA PPO 310
HPHC Insurance Company, Inc. HPHC Qualifying Student Health Plan HPHC 06-BR-MA-PPO
HPHC Insurance Company, Inc. Hospital PreferSM Best Buy PPO 1456 (Grp)/1459 (Ind) & SOB1455
Minuteman Health, Inc.3 MyDoc PPO National MHI-NatlPPO-EOC CLEAN-8112015
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/First Health
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Multiplan, Inc.
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Cigna PPO
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW PHCS 101 10/26/04
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CERT 101 5/19/03
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CIGNA 101
Neighborhood Health Plan, Inc. NHP PPO Prime NHPPPOv4
Neighborhood Health Plan, Inc. NHP PPO Prime (Small Group) PPOMMv1
Tufts Associated Health Maintenance Organization, Inc. Point of Service Option CC-MAPOS-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc. Preferred Provider Option MA-PPO-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc. PPO Basic Platinum MA-PPO-001 Ed. 1-2018
Tufts Associated Health Maintenance Organization, Inc. PPO Value Platinum MA-PPO-001 Ed. 1-2018
Tufts Insurance Company Advantage PPO MA-TICOPPO-001 Ed.1-2012
Tufts Insurance Company CareLink
 		 MA-TICOPPO-002 Ed. 1-2012
 
Tufts Insurance Company Student Health PPO MA-TICOPPO-003
Tufts Insurance Company Sports Accident PPO MA-TICPPO-SPACC-001 Ed. 1-2015
United HealthCare Insurance Company  Choice Plus (Large Group) COC.INS.2018.LG.MA & SBN.CHP.I.2018.LG.MA
United HealthCare Insurance Company  Choice Plus (Small Group) COC.INS.2018.SG.MA & SBN.CHC.I.2018.SG.MA
United HealthCare Insurance Company Options PPO  COC.INS.2018.LG.MA & SBN.OPT.I.2018.LG.MA
United HealthCare Insurance Company Transplant Benefit Certificate UCC-CERT-MA (02/04)
United HealthCare Insurance Company Options PPO Non-Differential COC.INS.2018.LG.MA & SBN.NDF.I.2018.LG.MA
United HealthCare Insurance Company Blanket Student PPO Injury & Sickness Benefits Group Policy COL-17-MA CERT


1 Form GR-96449 1005 ED. 01-10 et al to replace the originally filed form GR-96487-1 ED. 10-07 et al upon group's renewal date.
2 The "Savings Plus" Network tiers acute care hospitals & specialists.
3 Plan in-network coverage includes (1) providers who contract directly with MHI and (2) providers in the First Health Network when services are received OUTSIDE of the 7 counties in MHI’s Service Area.

*  Unicare Life and Health Insurance Company (Form #s BCR 100.1 MA 10/04 and BCR 105.1-MA 11/04). does not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts..

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Franklin County Preferred Provider Plan Medical Service

MEDICAL
Insured Preferred Provider Plans		 Product Name Form Number
Aetna Life Insurance Company Open Choice GR-9
Aetna Life Insurance Company Managed Choice GR-9
Aetna Life Insurance Company Student Blanket Policy GR96134
Aetna Life Insurance Company 1 Student Sports Accident Insurance GR-96449 1005 ED. 01-10 et al.
Blue Cross and Blue Shield of Massachusetts, Inc. Blue Care Elect BCBS-PPO (1-1-2013)
BCBSMA HMO Blue, Inc.
 		 Preferred Blue PPO Options
 		 HMO-PPO (1-1-2013)
 
BCBSMA HMO Blue, Inc. Preferred Blue PPO with Hospital Choice HMO-PPO (1-1-2013)
CIGNA Health and Life Insurance Company Point of Service HC-CER1, et al.
CIGNA Health and Life Insurance Company Point of Service Open Access HC-CER1, et al.
CIGNA Health and Life Insurance Company CareLink/Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company PPO HC-CER1, et al.
CIGNA Health and Life Insurance Company Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company Medical LocalPlus HC-CER1, et al.
ConnectiCare of Massachusetts, Inc. Point of Service Open Access CMI/POS OA/BS 01 (01/2017)
ConnectiCare of Massachusetts, Inc. Large Group Deductible CMI/POS  OA/BS 01 (01/2017)
ConnectiCare of Massachusetts, Inc. Choice Mass POS Copay $40 CMI/POS  OA/BS 01 (01/2018)
4 Ever Life Insurance Company GeoBlue Expat/Global ExPat 54.1315 (MA)
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Harvard Pilgrim Health Care, Inc. Standard PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Affordable PPO 25-Flex 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy HSA PPO 1829_04/1824_04;SOB 1826_03
Health New England, Inc. HNE Advantage Plus HNE/POSPLUS-06
Health New England, Inc. HNE Premier PPO HNE/PHCS-PPO-06
Health New England, Inc. HNE PPO Saver HNE/PHCS-PPOSaver-06
Health New England, Inc. HNE Wise PPO HNE/PHCS-PPOSaver-06
Health New England, Inc. HNE MedPlus PPO HNE/PHCS/PPO-07-Medicare-Grp
Health New England, Inc. HNE PPO Essential HNE-PPO-06 HNE/PHCS-PPO-06
HPHC Insurance Company, Inc. The PPO Plan  Massachusetts MAG1PPOHBREV
HPHC Insurance Company, Inc. Best Buy HSA PPO 310
HPHC Insurance Company, Inc. HPHC Qualifying Student Health Plan HPHC 06-BR-MA-PPO
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/First Health
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Multiplan, Inc.
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Cigna PPO
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW PHCS 101 10/26/04
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CERT 101 5/19/03
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CIGNA 101
Neighborhood Health Plan, Inc. NHP PPO Prime  NHPPPOv4
Neighborhood Health Plan, Inc. NHP PPO Prime (Small Group) PPOMMv1
Tufts Associated Health Maintenance Organization, Inc. Point of Service Option CC-MAPOS-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc. Preferred Provider Option MA-PPO-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc. PPO Basic Platinum MA-PPO-001 Ed. 1-2018
Tufts Associated Health Maintenance Organization, Inc. PPO Value Platinum MA-PPO-001 Ed. 1-2018
Tufts Insurance Company Advantage PPO MA-TICOPPO-001 Ed.1-2012
Tufts Insurance Company CareLink
 		 MA-TICOPPO-002 Ed. 1-2012
 
Tufts Insurance Company Student Health PPO MA-TICOPPO-003
Tufts Insurance Company Sports Accident PPO MA-TICPPO-SPACC-001 Ed. 1-2015
United HealthCare Insurance Company Options PPO  COC.INS.2018.LG.MA & SBN.OPT.I.2018.LG.MA
United HealthCare Insurance Company Transplant Benefit Certificate UCC-CERT-MA (02/04)
United HealthCare Insurance Company Options PPO Non-Differential
COC.INS.2018.LG.MA & SBN.NDF.I.2018.LG.MA
United HealthCare Insurance Company Blanket Student PPO Injury & Sickness Benefits Group Policy COL-17-MA CERT
United HealthCare Insurance Company Choice Plus (Large Group) COC.INS.2018.LG.MA & SBN.CHP.I.2018.LG.MA
United HealthCare Insurance Company Choice Plus (Small Group) COC.INS.2018.SG.MA & SBN.CHC.I.2018.SG.MA


1 Form GR-96449 1005 ED. 01-10 et al to replace the originally filed form GR-96487-1 ED. 10-07 et al upon group's renewal date.

* Unicare Life and Health Insurance Company (Form #s BCR 100.1 MA 10/04 and BCR 105.1-MA 11/04). does not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts.

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Hampden County Preferred Provider Plan Medical Service

MEDICAL
Insured Preferred Provider Plans		 Product Name Form Number
Aetna Life Insurance Company Open Choice GR-9
Aetna Life Insurance Company Managed Choice GR-9
Aetna Life Insurance Company Student Blanket Policy GR96134
Aetna Life Insurance Company 1 Student Sports Accident Insurance GR-96449 1005 ED. 01-10 et al.
Blue Cross and Blue Shield of Massachusetts, Inc. Blue Care Elect BCBS-PPO (1-1-2013)
BCBSMA HMO Blue, Inc.
 		 Preferred Blue PPO Options
 		 HMO-PPO (1-1-2013)
 
BCBSMA HMO Blue, Inc.
 		 Preferred Blue PPO with Hospital Choice HMO-PPO (1-1-2013)
CIGNA Health and Life Insurance Company Point of Service HC-CER1, et al.
CIGNA Health and Life Insurance Company Point of Service Open Access HC-CER1, et al.
CIGNA Health and Life Insurance Company CareLink/Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company PPO HC-CER1, et al.
CIGNA Health and Life Insurance Company Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company Medical LocalPlus HC-CER1, et al.
ConnectiCare of Massachusetts, Inc. Point of Service Open Access CMI/POS OA/BS 01 (01/2017)
ConnectiCare of Massachusetts, Inc. Large Group Deductible CMI/POS OA/BS 01 (01/2017)
ConnectiCare of Massachusetts, Inc. Choice Mass POS Copay $40 CMI/POS OA/BS 01 (01/2018)
4 Ever Life Insurance Company GeoBlue Expat/Global ExPat 54.1315 (MA)
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Harvard Pilgrim Health Care, Inc. Standard PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Affordable PPO 25-Flex 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy HSA PPO 1829_04/1824_04;SOB 1826_03
Health New England, Inc. HNE Advantage Plus HNE/POSPLUS-06
Health New England, Inc. HNE Premier PPO HNE/PHCS-PPO-06
Health New England, Inc. HNE PPO Saver HNE/PHCS-PPOSaver-06
Health New England, Inc. HNE Wise PPO HNE/PHCS-PPOSaver-06
Health New England, Inc. HNE MedPlus PPO HNE/PHCS/PPO-07-Medicare-Grp
Health New England, Inc. HNE PPO Essential HNE-PPO-06 HNE/PHCS-PPO-06
HPHC Insurance Company, Inc. The PPO Plan Massachusetts MAG1PPOHBREV
HPHC Insurance Company, Inc. Best Buy HSA PPO 310
HPHC Insurance Company, Inc. HPHC Qualifying Student Health Plan HPHC 06-BR-MA-PPO
HPHC Insurance Company, Inc Hospital PreferSM Best Buy PPO 1456 (Grp)/1459 (Ind) & SOB1455
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/First Health
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Multiplan, Inc.
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Cigna PPO
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW PHCS 101 10/26/04
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CERT 101 5/19/03
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CIGNA 101
Neighborhood Health Plan, Inc. NHP PPO Prime NHPPPOv4
Neighborhood Health Plan, Inc. NHP PPO Prime (Small Group) PPOMMv1
Tufts Associated Health Maintenance Organization, Inc. Point of Service Option CC-MAPOS-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc. Preferred Provider Option MA-PPO-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc. PPO Basic Platinum MA-PPO-001 Ed. 1-2018
Tufts Associated Health Maintenance Organization, Inc. PPO Value Platinum MA-PPO-001 Ed. 1-2018
Tufts Insurance Company Advantage PPO MA-TICOPPO-001 Ed.1-2012
Tufts Insurance Company CareLink
 		 MA-TICOPPO-002 Ed. 1-2012
 
Tufts Insurance Company Student Health PPO MA-TICOPPO-003
Tufts Insurance Company Sports Accident PPO MA-TICPPO-SPACC-001 Ed. 1-2015
United HealthCare Insurance Company  Choice Plus (Large Group) COC.INS.2018.LG.MA & SBN.CHP.I.2018.LG.MA
United HealthCare Insurance Company  Choice Plus (Small Group) COC.INS.2018.SG.MA & SBN.CHC.I.2018.SG.MA
United HealthCare Insurance Company Options PPO 
COC.INS.2018.LG.MA & SBN.OPT.I.2018.LG.MA
United HealthCare Insurance Company Transplant Benefit Certificate UCC-CERT-MA (02/04)
United HealthCare Insurance Company Options PPO Non-Differential COC.INS.2018.LG.MA & SBN.NDF.I.2018.LG.MA
United HealthCare Insurance Company Blanket Student PPO Injury & Sickness Benefits Group Policy COL-17-MA CERT

 1 Form GR-96449 1005 ED. 01-10 et al to replace the originally filed form GR-96487-1 ED. 10-07 et al upon group's renewal date.

* Unicare Life and Health Insurance Company (Form #s BCR 100.1 MA 10/04 and BCR 105.1-MA 11/04). does not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts.

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Hampshire County Preferred Provider Plan Medical Service

MEDICAL
Insured Preferred Provider Plans		 Product Name Form Number
Aetna Life Insurance Company Open Choice GR-9
Aetna Life Insurance Company Managed Choice GR-9
Aetna Life Insurance Company Student Blanket Policy GR96134
Aetna Life Insurance Company 1 Student Sports Accident Insurance GR-96449 1005 ED. 01-10 et al.
Blue Cross and Blue Shield of Massachusetts, Inc. Blue Care Elect BCBS-PPO (1-1-2013)
BCBSMA HMO Blue, Inc.
 		 Preferred Blue PPO Options
 		 HMO-PPO (1-1-2013)
 
BCBSMA HMO Blue, Inc. Preferred Blue PPO with Hospital Choice HMO-PPO (1-1-2013)
Combined Insurance Company of America Blanket Student Accident & Sickness UH P63003 0604 MA
CIGNA Health and Life Insurance Company Point of Service HC-CER1, et al.
CIGNA Health and Life Insurance Company Point of Service Open Access HC-CER1, et al.
CIGNA Health and Life Insurance Company CareLink/Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company PPO HC-CER1, et al.
CIGNA Health and Life Insurance Company Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company Medical LocalPlus HC-CER1, et al.
ConnectiCare of Massachusetts, Inc. Point of Service Open Access CMI/POS OA/BS 01 (01/2017)
ConnectiCare of Massachusetts, Inc. Large Group Deductible CMI/POS OA/BS 01 (01/2017)
ConnectiCare of Massachusetts, Inc. Choice Mass POS Copay $40 CMI/POS OA/BS 01 (01/2018)
4 Ever Life Insurance Company GeoBlue Expat/Global ExPat 54.1315 (MA)
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Harvard Pilgrim Health Care, Inc. Standard PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Affordable PPO 25-Flex 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy HSA PPO 1829_04/1824_04;SOB 1826_03
Health New England, Inc. HNE Advantage Plus HNE/POSPLUS-06
Health New England, Inc. HNE Premier PPO HNE/PHCS-PPO-06
Health New England, Inc. HNE PPO Saver HNE/PHCS-PPOSaver-06
Health New England, Inc. HNE Wise PPO HNE/PHCS-PPOSaver-06
Health New England, Inc. HNE MedPlus PPO HNE/PHCS/PPO-07-Medicare-Grp
Health New England, Inc. HNE PPO Essential HNE-PPO-06 HNE/PHCS-PPO-06
HPHC Insurance Company, Inc. The PPO Plan Massachusetts MAG1PPOHBREV
HPHC Insurance Company, Inc. Best Buy HSA PPO 310
HPHC Insurance Company, Inc. HPHC Qualifying Student Health Plan HPHC 06-BR-MA-PPO
HPHC Insurance Company, Inc. Hospital PreferSM Best Buy PPO 1456 (Grp)/1459 (Ind) & SOB1455
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/First Health
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Multiplan, Inc.
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Cigna PPO
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW PHCS 101 10/26/04
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CERT 101 5/19/03
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CIGNA 101
Neighborhood Health Plan, Inc. NHP PPO Prime  NHPPPOv4
Neighborhood Health Plan, Inc. NHP PPO Prime (Small Group) PPOMMv1
Tufts Associated Health Maintenance Organization, Inc. Point of Service Option CC-MAPOS-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc. Preferred Provider Option MA-PPO-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc. PPO Basic Platinum MA-PPO-001 Ed. 1-2018
Tufts Associated Health Maintenance Organization, Inc.  PPO Value Platinum MA-PPO-001 Ed. 1-2018
Tufts Insurance Company Advantage PPO MA-TICOPPO-001 Ed.1-2012
Tufts Insurance Company CareLink
 		 MA-TICOPPO-002 Ed. 1-2012
 
Tufts Insurance Company Student Health PPO MA-TICOPPO-003
Tufts Insurance Company Sports Accident PPO MA-TICPPO-SPACC-001 Ed. 1-2015
United HealthCare Insurance Company Options PPO  COC.INS.2018.LG.MA & SBN.OPT.I.2018.LG.MA
United HealthCare Insurance Company Transplant Benefit Certificate UCC-CERT-MA (02/04)
United HealthCare Insurance Company Options PPO Non-Differential
COC.INS.2018.LG.MA & SBN.NDF.I.2018.LG.MA
United HealthCare Insurance Company Blanket Student PPO Injury & Sickness Benefits Group Policy COL-17-MA CERT
United HealthCare Insurance Company Choice Plus (Large Group) COC.INS.2018.LG.MA & SBN.CHP.I.2018.LG.MA
United HealthCare Insurance Company Choice Plus (Small Group) COC.INS.2018.SG.MA & SBN.CHC.I.2018.SG.MA


1 Form GR-96449 1005 ED. 01-10 et al to replace the originally filed form GR-96487-1 ED. 10-07 et al upon group's renewal date.

*  Unicare Life and Health Insurance Company (Form #s BCR 100.1 MA 10/04 and BCR 105.1-MA 11/04). does not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts.

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Middlesex County Preferred Provider Plan Medical Service

MEDICAL
Insured Preferred Provider Plans		 Product Name Form Number
Aetna Life Insurance Company Open Choice GR-9
Aetna Life Insurance Company Managed Choice GR-9
Aetna Life Insurance Company Student Blanket Policy GR96134
Aetna Life Insurance Company 1 Student Sports Accident Insurance GR-96449 1005 ED. 01-10 et al.
Aetna Life Insurance Company 2 Savings Plus GR-9 et al.
Blue Cross and Blue Shield of Massachusetts, Inc. Blue Care Elect BCBS-PPO (1-1-2013)
BCBSMA HMO Blue, Inc. Preferred Blue PPO Options HMO-PPO (1-1-2013)
BCBSMA HMO Blue, Inc. Preferred Blue PPO with Hospital Choice HMO-PPO (1-1-2013)
CIGNA Health and Life Insurance Company Point of Service HC-CER1, et al.
CIGNA Health and Life Insurance Company Point of Service Open Access HC-CER1, et al.
CIGNA Health and Life Insurance Company CareLink/Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company PPO HC-CER1, et al.
CIGNA Health and Life Insurance Company Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company Medical LocalPlus HC-CER1, et al.
Combined Insurance Company of America Blanket Student Accident & Sickness UH C63009 0803 MA
4 Ever Life Insurance Company GeoBlue Expat/Global ExPat 54.1315 (MA)
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Harvard Pilgrim Health Care, Inc. Standard PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Affordable PPO 25-Flex 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy HSA PPO 1829_04/1824_04;SOB 1826_03
HPHC Insurance Company, Inc. The PPO Plan Massachusetts MAG1PPOHBREV
HPHC Insurance Company, Inc. Best Buy HSA PPO 310
HPHC Insurance Company, Inc. HPHC Qualifying Student Health Plan HPHC 06-BR-MA-PPO
HPHC Insurance Company, Inc. Hospital PreferSM Best Buy PPO 1456 (Grp)/1459 (Ind) & SOB1455
Minuteman Health, Inc.3 MyDoc PPO National MHI-NatlPPO-EOC CLEAN-8112015
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/First Health
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Multiplan, Inc.
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Cigna PPO
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW PHCS 101 10/26/04
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CERT 101 5/19/03
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CIGNA 101
Neighborhood Health Plan, Inc. NHP PPO Prime NHPPPOv4
Neighborhood Health Plan, Inc. NHP PPO Prime (Small Group) PPOMMv1
Tufts Associated Health Maintenance Organization, Inc.   Point of Service Option

 CC-MAPOS-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc.  Preferred Provider Option  MA-PPO-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc. PPO Basic Platinum MA-PPO-001 Ed. 1-2018
Tufts Associated Health Maintenance Organization, Inc. PPO Value Platinum MA-PPO-001 Ed. 1-2018
Tufts Insurance Company Advantage PPO MA-TICOPPO-001 Ed.1-2012
Tufts Insurance Company CareLink
 		 MA-TICOPPO-002 Ed. 1-2012
 
Tufts Insurance Company Student Health PPO MA-TICOPPO-003
Tufts Insurance Company Sports Accident PPO MA-TICPPO-SPACC-001 Ed. 1-2015
United HealthCare Insurance Company  Choice Plus (Large Group) COC.INS.2018.LG.MA & SBN.CHP.I.2018.LG.MA
United HealthCare Insurance Company  Choice Plus (Small Group) COC.INS.2018.SG.MA & SBN.CHC.I.2018.SG.MA
United HealthCare Insurance Company Options PPO 
COC.INS.2018.LG.MA & SBN.OPT.I.2018.LG.MA
United HealthCare Insurance Company Transplant Benefit Certificate UCC-CERT-MA (02/04)
United HealthCare Insurance Company Options PPO Non-Differential COC.INS.2018.LG.MA & SBN.NDF.I.2018.LG.MA
United HealthCare Insurance Company Blanket Student PPO Injury & Sickness Benefits Group Policy COL-17-MA CERT


1 Form GR-96449 1005 ED. 01-10 et al to replace the originally filed form GR-96487-1 ED. 10-07 et al upon group's renewal date.
2 The "Savings Plus" Network tiers acute care hospitals & specialists.
3 Plan in-network coverage includes (1) providers who contract directly with MHI and (2) providers in the First Health Network when services are received OUTSIDE of the 7 counties in MHI’s Service Area.

*  Unicare Life and Health Insurance Company (Form #s BCR 100.1 MA 10/04 and BCR 105.1-MA 11/04). does not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts.

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Nantucket County Preferred Provider Plan Medical Service

MEDICAL
Insured Preferred Provider Plans		 Product Name Form Number
BCBSMA HMO Blue, Inc. Preferred Blue PPO Options HMO-PPO (1-1-2013)
BCBSMA HMO Blue, Inc. Preferred Blue PPO with Hospital Choice HMO-PPO (1-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue Care Elect BCBS-PPO (1-1-2013)
CIGNA Health and Life Insurance Company Point of Service HC-CER1, et al.
CIGNA Health and Life Insurance Company Point of Service Open Access HC-CER1, et al.
CIGNA Health and Life Insurance Company CareLink/Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company PPO HC-CER1, et al.
CIGNA Health and Life Insurance Company Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company Medical LocalPlus HC-CER1, et al.
4 Ever Life Insurance Company GeoBlue Expat/Global ExPat 54.1315 (MA)
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Harvard Pilgrim Health Care, Inc. Standard PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Affordable PPO 25-Flex 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy HSA PPO 1829_04/1824_04;SOB 1826_03
HPHC Insurance Company, Inc. The PPO Plan-Massachusetts MAG1PPOHBREV
HPHC Insurance Company, Inc. Best Buy HSA PPO 310
HPHC Insurance Company, Inc. HPHC Qualifying Student Health Plan HPHC 06-BR-MA-PPO
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/First Health
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Multiplan, Inc.
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Cigna PPO
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW PHCS 101 10/26/04
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CERT 101 5/19/03
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CIGNA 101
Neighborhood Health Plan, Inc. NHP PPO Prime NHPPPOv4
Neighborhood Health Plan, Inc. NHP PPO Prime (Small Group) PPOMMv1
Tufts Associated Health Maintenance Organization, Inc. Point of Service Option  CC-MAPOS-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc. Preferred Provider Option   MA-PPO-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc. PPO Basic Platinum MA-PPO-001 Ed. 1-2018
Tufts Associated Health Maintenance Organization, Inc. PPO Value Platinum MA-PPO-001 Ed. 1-2018
Tufts Insurance Company Advantage PPO MA-TICOPPO-002 Ed. 1-2012
Tufts Insurance Company CareLink MA-TICOPPO-001 Ed.1-2012
Tufts Insurance Company Student Health PPO MA-TICOPPO-003
Tufts Insurance Company Sports Accident PPO MA-TICPPO-SPACC-001 Ed. 1-2015
United HealthCare Insurance Company Transplant Benefit Certificate UCC-CERT-MA (02/04)
United HealthCare Insurance Company Choice Plus (Large Group) COC.INS.2018.LG.MA & SBN.CHP.I.2018.LG.MA
United HealthCare Insurance Company Choice Plus (Small Group) COC.INS.2018.SG.MA & SBN.CHC.I.2018.SG.MA
United HealthCare Insurance Company Options PPO Non-Differential COC.INS.2018.LG.MA & SBN.NDF.I.2018.LG.MA

1Effective April 10, 2007, Fortis Insurance Company changed its name to Time Insurance Company.

*  Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - Unicare Life and Health Insurance Company (Form #s BCR 100.1 MA 10/04 and BCR 105.1-MA 11/04) and United HealthCare Insurance Company (Form# CPCEMA497).

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Norfolk County Preferred Provider Plan Medical Service

MEDICAL
Insured Preferred Provider Plans		 Product Name Form Number
Aetna Life Insurance Company Open Choice GR-9
Aetna Life Insurance Company Managed Choice GR-9
Aetna Life Insurance Company Student Blanket Policy GR96134
Aetna Life Insurance Company 1 Student Sports Accident Insurance GR-96449 1005 ED. 01-10 et al.
Aetna Life Insurance Company 2 Savings Plus GR-9 et al.
Blue Cross and Blue Shield of Massachusetts, Inc. Blue Care Elect BCBS-PPO (1-1-2013)
BCBSMA HMO Blue, Inc. Preferred Blue PPO Options HMO-PPO (1-1-2013)
BCBSMA HMO Blue, Inc. Preferred Blue PPO with Hospital Choice HMO-PPO (1-1-2013)
CIGNA Health and Life Insurance Company Point of Service HC-CER1, et al.
CIGNA Health and Life Insurance Company Point of Service Open Access HC-CER1, et al.
CIGNA Health and Life Insurance Company CareLink/Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company PPO HC-CER1, et al.
CIGNA Health and Life Insurance Company Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company Medical LocalPlus HC-CER1, et al.
4 Ever Life Insurance Company GeoBlue Expat/Global ExPat 54.1315 (MA)
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Harvard Pilgrim Health Care, Inc. Standard PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Affordable PPO 25-Flex 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy HSA PPO 1829_04/1824_04;SOB 1826_03
HPHC Insurance Company, Inc. The PPO Plan Massachusetts MAG1PPOHBREV
HPHC Insurance Company, Inc. Best Buy HSA PPO 310
HPHC Insurance Company, Inc. HPHC Qualifying Student Health Plan HPHC 06-BR-MA-PPO
HPHC Insurance Company, Inc. Hospital PreferSM Best Buy PPO 1456 (Grp)/1459 (Ind) & SOB1455
Minuteman Health, Inc.3 MyDoc PPO National MHI-NatlPPO-EOC CLEAN-8112015
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/First Health
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Multiplan, Inc.
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Cigna PPO
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW PHCS 101 10/26/04
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CERT 101 5/19/03
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CIGNA 101
Neighborhood Health Plan, Inc. NHP PPO Prime NHPPPOv4
Neighborhood Health Plan, Inc. NHP PPO Prime (Small Group) PPOMMv1
Tufts Associated Health Maintenance Organization, Inc. Point of Service Option CC-MAPOS-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc. Preferred Provider Option  MA-PPO-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc. PPO Basic Platinum MA-PPO-001 Ed. 1-2018
Tufts Associated Health Maintenance Organization, Inc. PPO Value Platinum MA-PPO-001 Ed. 1-2018
Tufts Insurance Company Advantage PPO MA-TICOPPO-001 Ed.1-2012
Tufts Insurance Company CareLink
 		 MA-TICOPPO-002 Ed. 1-2012
 
Tufts Insurance Company Student Health PPO MA-TICOPPO-003
Tufts Insurance Company Sports Accident PPO MA-TICPPO-SPACC-001 Ed. 1-2015
United HealthCare Insurance Company  Choice Plus (Large Group) COC.INS.2018.LG.MA & SBN.CHP.I.2018.LG.MA
United HealthCare Insurance Company  Choice Plus (Small Group) COC.INS.2018.SG.MA & SBN.CHC.I.2018.SG.MA
United HealthCare Insurance Company Options PPO 
COC.INS.2018.LG.MA & SBN.OPT.I.2018.LG.MA
United HealthCare Insurance Company Transplant Benefit Certificate UCC-CERT-MA (02/04)
United HealthCare Insurance Company Options PPO Non-Differential COC.INS.2018.LG.MA & SBN.NDF.I.2018.LG.MA
United HealthCare Insurance Company Blanket Student PPO Injury & Sickness Benefits Group Policy COL-17-MA CERT


1 Form GR-96449 1005 ED. 01-10 et al to replace the originally filed form GR-96487-1 ED. 10-07 et al upon group's renewal date.
2 The "Savings Plus" Network tiers acute care hospitals & specialists.
3 Plan in-network coverage includes (1) providers who contract directly with MHI and (2) providers in the First Health Network when services are received OUTSIDE of the 7 counties in MHI’s Service Area.

*  Unicare Life and Health Insurance Company (Form #s BCR 100.1 MA 10/04 and BCR 105.1-MA 11/04). does not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts.

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Plymouth County Preferred Provider Plan Medical Service

MEDICAL
Insured Preferred Provider Plans		 Product Name Form Number
Aetna Life Insurance Company Open Choice GR-9
Aetna Life Insurance Company Managed Choice GR-9
Aetna Life Insurance Company Student Blanket Policy GR96134
Aetna Life Insurance Company 1 Student Sports Accident Insurance GR-96449 1005 ED. 01-10 et al.
Aetna Life Insurance Company 2 Savings Plus GR-9 et al.
BCBSMA HMO Blue, Inc. Preferred Blue PPO Options HMO-PPO (1-1-2013)
BCBSMA HMO Blue, Inc. Preferred Blue PPO with Hospital Choice HMO-PPO (1-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue Care Elect BCBS-PPO (1-1-2013)
Combined Insurance Company of America Blanket Student Accident & Sickness UH P63003 0604 MA
CIGNA Health and Life Insurance Company Point of Service HC-CER1, et al.
CIGNA Health and Life Insurance Company Point of Service Open Access HC-CER1, et al.
CIGNA Health and Life Insurance Company CareLink/Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company PPO HC-CER1, et al.
CIGNA Health and Life Insurance Company Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company Medical LocalPlus HC-CER1, et al.
4 Ever Life Insurance Company GeoBlue Expat/Global ExPat 54.1315 (MA)
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Harvard Pilgrim Health Care, Inc. Standard PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Affordable PPO 25-Flex 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy HSA PPO 1829_04/1824_04;SOB 1826_03
HPHC Insurance Company, Inc. The PPO Plan Massachusetts MAG1PPOHBREV
HPHC Insurance Company, Inc. Best Buy HSA PPO 310
HPHC Insurance Company, Inc. HPHC Qualifying Student Health Plan HPHC 06-BR-MA-PPO
HPHC Insurance Company, Inc. Hospital PreferSM Best Buy PPO 1456 (Grp)/1459 (Ind) & SOB1455
Minuteman Health, Inc.3 MyDoc PPO National MHI-NatlPPO-EOC CLEAN-8112015
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/First Health
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Multiplan, Inc.
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Cigna PPO
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW PHCS 101 10/26/04
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CERT 101 5/19/03
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CIGNA 101
Neighborhood Health Plan, Inc. NHP PPO Prime NHPPPOv4
Neighborhood Health Plan, Inc. NHP PPO Prime (Small Group) PPOMMv1
Tufts Associated Health Maintenance Organization, Inc. Point of Service Option CC-MAPOS-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc. Preferred Provider Option MA-PPO-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc. PPO Basic Platinum MA-PPO-001 Ed. 1-2018
Tufts Associated Health Maintenance Organization, Inc. PPO Value Platinum MA-PPO-001 Ed. 1-2018
Tufts Insurance Company
 		 Advantage PPO MA-TICOPPO-001 Ed.1-2012
Tufts Insurance Company
 		 CareLink
 		 MA-TICOPPO-002 Ed. 1-2012
 
Tufts Insurance Company Student Health PPO MA-TICOPPO-003
Tufts Insurance Company Sports Accident PPO MA-TICPPO-SPACC-001 Ed. 1-2015
United HealthCare Insurance Company  Choice Plus (Large Group) COC.INS.2018.LG.MA & SBN.CHP.I.2018.LG.MA
United HealthCare Insurance Company Choice Plus (Small Group) COC.INS.2018.SG.MA & SBN.CHC.I.2018.SG.MA
United HealthCare Insurance Company Options PPO  COC.INS.2018.LG.MA & SBN.OPT.I.2018.LG.MA
United HealthCare Insurance Company Transplant Benefit Certificate UCC-CERT-MA (02/04)
United HealthCare Insurance Company Options PPO Non-Differential COC.INS.2018.LG.MA & SBN.NDF.I.2018.LG.MA
United HealthCare Insurance Company Blanket Student PPO Injury & Sickness Benefits Group Policy COL-17-MA CERT



1 Form GR-96449 1005 ED. 01-10 et al to replace the originally filed form GR-96487-1 ED. 10-07 et al upon group's renewal date.
2 The "Savings Plus" Network tiers acute care hospitals & specialists.
3 Plan in-network coverage includes (1) providers who contract directly with MHI and (2) providers in the First Health Network when services are received OUTSIDE of the 7 counties in MHI’s Service Area.

*  Unicare Life and Health Insurance Company (Form #s BCR 100.1 MA 10/04 and BCR 105.1-MA 11/04). does not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts.

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Suffolk County Preferred Provider Plan Medical Service

MEDICAL
Insured Preferred Provider Plans		 Product Name Form Number
Aetna Life Insurance Company Open Choice GR-9
Aetna Life Insurance Company Managed Choice GR-9
Aetna Life Insurance Company Student Blanket Policy GR96134
Aetna Life Insurance Company 1 Student Sports Accident Insurance GR-96449 1005 ED. 01-10 et al.
Aetna Life Insurance Company 2 Savings Plus GR-9 et al.
BCBSMA HMO Blue, Inc. Preferred Blue PPO Options HMO-PPO (1-1-2013)
BCBSMA HMO Blue, Inc. Preferred Blue PPO with Hospital Choice HMO-PPO (1-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue Care Elect BCBS-PPO (1-1-2013)
CIGNA Health and Life Insurance Company Point of Service HC-CER1, et al.
CIGNA Health and Life Insurance Company Point of Service Open Access HC-CER1, et al.
CIGNA Health and Life Insurance Company CareLink/Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company PPO HC-CER1, et al.
CIGNA Health and Life Insurance Company Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company Medical LocalPlus HC-CER1, et al.
4 Ever Life Insurance Company GeoBlue Expat/Global ExPat 54.1315 (MA)
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Harvard Pilgrim Health Care, Inc. Standard PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Affordable PPO 25-Flex 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy HSA PPO 1829_04/1824_04;SOB 1826_03
HPHC Insurance Company, Inc. The PPO Plan Massachusetts MAG1PPOHBREV
HPHC Insurance Company, Inc. Best Buy HSA PPO 310
HPHC Insurance Company, Inc. HPHC Qualifying Student Health Plan HPHC 06-BR-MA-PPO
HPHC Insurance Company, Inc. Hospital PreferSM Best Buy PPO 1456 (Grp)/1459 (Ind) & SOB1455
Minuteman Health, Inc.3 MyDoc PPO National MHI-NatlPPO-EOC CLEAN-8112015
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/First Health
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Multiplan, Inc.
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Cigna PPO
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW PHCS 101 10/26/04
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CERT 101 5/19/03
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CIGNA 101
Neighborhood Health Plan, Inc. NHP PPO Prime  NHPPPOv4
Neighborhood Health Plan, Inc. NHP PPO Prime (Small Group) PPOMMv1
Tufts Associated Health Maintenance Organization, Inc. Point of Service Option CC-MAPOS-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc. Preferred Provider Option  MA-PPO-001 Ed. 1-2017 
Tufts Associated Health Maintenance Organization, Inc. PPO Basic Platinum MA-PPO-001 Ed. 1-2018
Tufts Associated Health Maintenance Organization, Inc. PPO Value Platinum MA-PPO-001 Ed. 1-2018
Tufts Insurance Company Advantage PPO MA-TICOPPO-001 Ed.1-2012
Tufts Insurance Company CareLink
 		 MA-TICOPPO-002 Ed. 1-2012
 
Tufts Insurance Company Student Health PPO MA-TICOPPO-003
Tufts Insurance Company Sports Accident PPO MA-TICPPO-SPACC-001 Ed. 1-2015
United HealthCare Insurance Company  Choice Plus (Large Group) COC.INS.2018.LG.MA & SBN.CHP.I.2018.LG.MA
United HealthCare Insurance Company Choice Plus (Small Group) COC.INS.2018.SG.MA & SBN.CHC.I.2018.SG.MA
United HealthCare Insurance Company Options PPO  COC.INS.2018.LG.MA & SBN.OPT.I.2018.LG.MA
United HealthCare Insurance Company Transplant Benefit Certificate UCC-CERT-MA (02/04)
United HealthCare Insurance Company Options PPO Non-Differential COC.INS.2018.LG.MA & SBN.NDF.I.2018.LG.MA
United HealthCare Insurance Company Blanket Student PPO Injury & Sickness Benefits Group Policy COL-17-MA CERT



1 Form GR-96449 1005 ED. 01-10 et al to replace the originally filed form GR-96487-1 ED. 10-07 et al upon group's renewal date.
2 The "Savings Plus" Network tiers acute care hospitals & specialists.
3 Plan in-network coverage includes (1) providers who contract directly with MHI and (2) providers in the First Health Network when services are received OUTSIDE of the 7 counties in MHI’s Service Area.

*  Unicare Life and Health Insurance Company (Form #s BCR 100.1 MA 10/04 and BCR 105.1-MA 11/04). does not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts.

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Worcester County Preferred Provider Plan Medical Service

MEDICAL
Insured Preferred Provider Plans		 Product Name Form Number
Aetna Life Insurance Company Open Choice GR-9
Aetna Life Insurance Company Managed Choice GR-9
Aetna Life Insurance Company Student Blanket Policy GR96134
Aetna Life Insurance Company 1 Student Sports Accident Insurance GR-96449 1005 ED. 01-10 et al.
Blue Cross and Blue Shield of Massachusetts, Inc. Blue Care Elect BCBS-PPO (1-1-2013)
BCBSMA HMO Blue, Inc. Preferred Blue PPO Options HMO-PPO (1-1-2013)
BCBSMA HMO Blue, Inc. Preferred Blue PPO with Hospital Choice HMO-PPO (1-1-2013)
CIGNA Health and Life Insurance Company Point of Service HC-CER1, et al.
CIGNA Health and Life Insurance Company Point of Service Open Access HC-CER1, et al.
CIGNA Health and Life Insurance Company CareLink/Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company PPO HC-CER1, et al.
CIGNA Health and Life Insurance Company Open Access Plus HC-CER1, et al.
CIGNA Health and Life Insurance Company Medical LocalPlus HC-CER1, et al.
ConnectiCare of Massachusetts, Inc. Point of Service Open Access CMI/POS OA/BS 01 (01/2017)
ConnectiCare of Massachusetts, Inc. Large Group Deductible CMI/POS OA/BS 01 (01/2017)
ConnectiCare of Massachusetts, Inc. Choice Mass POS Copay $40 CMI/POS OA/BS 01 (01/2018)
4 Ever Life Insurance Company GeoBlue Expat/Global ExPat 54.1315 (MA)
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Fallon Health & Life Assurance Company Fallon Preferred Care 15-670-031
Harvard Pilgrim Health Care, Inc. Standard PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Best Buy Tiered Copayment PPO 1133_09 & SOB 1561_03
Harvard Pilgrim Health Care, Inc. Affordable PPO 25-Flex 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy PPO 1138_11/1133_11;SOB 1569_04
Harvard Pilgrim Health Care, Inc. Best Buy HSA PPO 1829_04/1824_04;SOB 1826_03
Health New England, Inc. HNE Advantage Plus HNE/POSPLUS-06
Health New England, Inc. HNE Premier PPO HNE/PHCS-PPO-06
Health New England, Inc. HNE PPO Saver HNE/PHCS-PPOSaver-06
Health New England, Inc. HNE Wise PPO HNE/PHCS-PPOSaver-06
Health New England, Inc. HNE MedPlus PPO HNE/PHCS/PPO-07-Medicare-Grp
Health New England, Inc. HNE PPO Essential HNE-PPO-06 HNE/PHCS-PPO-06
HPHC Insurance Company, Inc. The PPO Plan Massachusetts MAG1PPOHBREV
HPHC Insurance Company, Inc. Best Buy HSA PPO 310
HPHC Insurance Company, Inc. HPHC Qualifying Student Health Plan HPHC 06-BR-MA-PPO
HPHC Insurance Company, Inc. Hospital PreferSM Best Buy PPO 1456 (Grp)/1459 (Ind) & SOB1455
Minuteman Health, Inc.2 MyDoc PPO National MHI-NatlPPO-EOC CLEAN-8112015
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/First Health
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Multiplan, Inc.
National Guardian Life Insurance Company Consolidated Health Plans, Inc. NBHCert-280(2014) PPO MA w/Cigna PPO
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW PHCS 101 10/26/04
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CERT 101 5/19/03
Nationwide Life Insurance Company Student Acc. & Sickness Ins. Program NW CIGNA 101
Neighborhood Health Plan, Inc. NHP PPO Prime NHPPPOv4
Neighborhood Health Plan, Inc. NHP PPO Prime (Small Group) PPOMMv1
Tufts Associated Health Maintenance Organization, Inc. Point of Service Option CC-MAPOS-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc. Preferred Provider Option MA-PPO-001 Ed. 1-2017
Tufts Associated Health Maintenance Organization, Inc. PPO Basic Platinum MA-PPO-001 Ed. 1-2018
Tufts Associated Health Maintenance Organization, Inc. PPO Value Platinum MA-PPO-001 Ed. 1-2018
Tufts Insurance Company Advantage PPO MA-TICOPPO-001 Ed.1-2012
Tufts Insurance Company CareLink
 		 MA-TICOPPO-002 Ed. 1-2012
 
Tufts Insurance Company Student Health PPO MA-TICOPPO-003
Tufts Insurance Company Sports Accident PPO MA-TICPPO-SPACC-001 Ed. 1-2015
United HealthCare Insurance Company  Choice Plus (Large Group) COC.INS.2018.LG.MA & SBN.CHP.I.2018.LG.MA
United HealthCare Insurance Company  Choice Plus (Small Group) COC.INS.2018.SG.MA & SBN.CHC.I.2018.SG.MA
United HealthCare Insurance Company Options PPO  COC.INS.2018.LG.MA & SBN.OPT.I.2018.LG.MA
United HealthCare Insurance Company Transplant Benefit Certificate UCC-CERT-MA (02/04)
United HealthCare Insurance Company Options PPO Non-Differential COC.INS.2018.LG.MA & SBN.NDF.I.2018.LG.MA
United HealthCare Insurance Company Blanket Student PPO Injury & Sickness Benefits Group Policy COL-17-MA CERT



1 Form GR-96449 1005 ED. 01-10 et al to replace the originally filed form GR-96487-1 ED. 10-07 et al upon group's renewal date.

2 Plan in-network coverage includes (1) providers who contract directly with MHI and (2) providers in the First Health Network when services are received OUTSIDE of the 7 counties in MHI’s Service Area.

*  Unicare Life and Health Insurance Company (Form #s BCR 100.1 MA 10/04 and BCR 105.1-MA 11/04). does not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts.

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