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What type of plan is Harvard Pilgrim?

These plans can be HMO or PPO. Your employees meet a deductible before services are paid by Harvard Pilgrim. Sometimes the plan will have a funding arrangement like an HRA or an HSA to help them meet their deductible.

What happened to Harvard Pilgrim Health Care?

Tufts Health Plan and Harvard Pilgrim Health Care are now part of one combined organization. For the time being, however, Tufts and Harvard Pilgrim will continue to operate as separate companies and keep their current respective company names. A new name for the combined company is expected in the coming months.

Does Harvard Pilgrim require prior authorization?

Harvard Pilgrim requires prior authorization (prospective review of medical necessity and clinical appropriateness) for selected medications, procedures, services and items.

Where does Harvard Pilgrim cover?

We offer a variety of affordable individual and family plans built to support you and your family no matter what life throws at you. Plus, learn more about the employer-sponsored group plans we offer in Massachusetts, Connecticut, Maine and New Hampshire.

What is prior authorization and when does the MA need to obtain it?

Prior authorization is a requirement that a health care provider obtain approval from Medicare to provide a given service. Prior Authorization is about cost-savings, not care. Under Prior Authorization, benefits are only paid if the medical care has been pre-approved by Medicare.

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