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2013 Tufts HMO Premium Summary of Benefit Coverage - brandeis

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The document outlines the Tufts Premium HMO health plan, which complies with Massachusetts' Minimum Creditable Coverage standards effective January 1, 2009. It details the requirements for Massachusetts residents to have health insurance, summarizes benefits and coverage specifics for the plan year 2013, including costs for various medical services, copayments, and exclusions. Additionally, it provides information on rights to continue coverage, grievance procedures, and consumer assistance resources.

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What is the difference between Tufts HMO and PPO?

Tufts Health Plan offers HMO and PPO Medicare Advantage plans. Both plan types provide comprehensive coverage beyond Original Medicare. With an HMO plan you choose a primary care physician to help coordinate your care. With a PPO plan you can see any doctor but are responsible for coordinating your care.

What is Tufts Health Plan PPO?

PPO plans. A PPO plan allows for members to receive care from any doctor without the need of a referral from a primary care physician. If providing your employees with the flexibility to see any provider they choose is important to you, a PPO is the ideal option.

Is Tufts Health Plan an HMO?

Your plan is a Health Maintenance Organization (HMO) plan, meaning it includes a network of doctors, specialists, hospitals, and pharmacies. Your plan offers coverage for services you get within the network. In most cases, if you receive care from an out-of-network doctor or facility, you will not be covered.

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