Tufts PPO Plan

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 benefits@berklee.edu.

 In-Network (Tufts Providers)Out-of-Network (Non-Tufts Providers)
DeductibleNoneIndividual $250, Family $500
Preventive CareCovered in Full20% Coinsurance
Annual PhysicalCovered in Full20% Coinsurance
Office Visit$25 per Visit20% Coinsurance
Routine Vision Exam$25 per Visit, 1 Exam Every 12 Months20% Coinsurance
Emergency Room$150 per Visit $100 per Visit 
Inpatient HospitalCovered in Full20% Coinsurance
Out-of-Pocket MaximumIndividual $2,500, Family $5,000Individual $2,500, Family $5,000
Prescription Drugs (in-Network Only )

Tier 1

Low Cost Generic

Tier 2

High Cost Generic

Tier 3

Preferred Brand

Tier 4

Non-Preferred Brand

Retail (30-Day Supply)$5$20$30$50
Mail Order (90-Day Supply)$10$40$60$150
Specialty Drugs (in-Network Only)Special pricing may apply. 

Full PPO Cost Summary 2023

  • 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.