You have a choice with this health insurance option. The PPO plan provides a higher level of benefits (in-network) if you use health care providers in Tufts Health Plan's network, and a lower level of benefits if you use non-network providers. You do not need to name a primary care provider (PCP) or receive referrals for specialist visits. This freedom of choice comes at the cost of a higher premium for you than you would pay under the HMO option.
During personal travel outside of the New England area, you may need to pay for health care costs and then apply for reimbursement from the plan.
For information about health care while traveling for business outside of the New England network, contact us at firstname.lastname@example.org.
|In-Network (Tufts Providers)||Out-of-Network (Non-Tufts Providers)|
|Deductible||None||Individual $250, Family $500|
|Preventive Care||Covered in Full||20% Coinsurance|
|Annual Physical||Covered in Full||20% Coinsurance|
|Office Visit||$25 per visit||20% Coinsurance|
|Routine Vision Exam||$25 per Visit, 1Visit Every 12 Months||20% Coinsurance|
|Emergency Room||$100 per Visit (Waived if Admitted)||$100 per Visit (Waived if Admitted)|
|Inpatient Hospital||Covered in Full||20% Coinsurance|
|Out-of-Pocket Maximum||Individual $2,500, Family $5,000||Individual $2,500, Family $5,000|
|Prescription Drugs (in/out of Network)||Tier 1||Tier 2||Tier 3|
|Retail (30-Day Supply)||$15||$30||$50|
|Mail Order (90-Day Supply)||$30||$60||$150|
|Specialty Drugs (in-Network Only)||Special pricing may apply.|
- Consider enrolling in a health care FSA to pay for copays and other services not covered by the plan.
- The PPO option costs significantly more than the HMO option. Carefully consider whether you need the out-of-network benefits of the PPO. If not, save money by choosing the HMO.