Take Advantage of Our Advantage Plans

Tufts Health Plan understands that you need to offer your employees superior health care coverage while keeping costs affordable. Our selection of cost-sharing “Advantage” plans offer traditional coverage on an HMO or PPO platform with a front-end member deductible and feature all of the same quality extras you’ve come to expect from us.

The plans can be combined with a Health Reimbursement Arrangement (HRA) or Health Savings Account (HSA)—to offset the member’s out-of-pocket costs.

Our Advantage plans offer your employees an incentive to choose the most cost-effective and appropriate care by sharing more of the costs associated with health care services. We want to encourage members, with the consultation of their providers, to make decisions about their health care that can help prevent illness and lead them to maintain or begin a healthier lifestyle. These Advantage plans provide a foundation for members to engage in their care, because they are responsible for decisions on how to spend their deductible dollars on services.

Advantage HMO
Tufts Health Plan Advantage HMO is a front-end deductible HMO. A Health Reimbursement Arrangement (HRA) can be added that employees can use for out-of-pocket expenses incurred with respect to the deductible and copayments. It works like a traditional HMO, but with several key differences. Plan features include:

• A front-end deductible (choose either $500, $1000, $1500, or $2000) that applies for inpatient hospital care, day surgery, outpatient diagnostic, and certain other services. Once the deductible is satisfied, the plan will cover 100% of covered services subject to the deductible.
• Preventive office visits and specialist consultations are covered with a copayment for each visit. Services to diagnose, treat, or monitor health conditions are subject to the deductible.
• Emergency room care is covered with a copayment—the deductible does not apply.
• Members must choose a Primary Care Provider who provides or arranges their care from Tufts Health Plan’s Network of more than 22,000 physicians and 85 hospitals to provide or arrange for care. Except in an emergency, care must be received from network providers.
• The optional Health Reimbursement Arrangement (HRA) allows you to prefund some of your employees’ out-of-pocket medical expenses.

Advantage PPO
Tufts Health Plan Advantage PPO is a front-end deductible PPO plan. A Health Reimbursement Arrangement (HRA) can be added—an employer-funded account administered by one of our third party administrators—that employees can use for out-of-pocket expenses incurred with respect to the deductible and copayments. The PPO platform provides coverage for both in- and out-of-network services and this option has several key differences from a standard PPO. The plan features:

• A front-end deductible that applies to both in-and out-of-network for inpatient hospital care, day surgery, outpatient diagnostic services, and certain other services. For in-network services, once the deductible is satisfied, the plan will pay 100% of eligible charges that are subject to the deductible. For out-of-network services, once the deductible has been satisfied, the plan will pay a percentage of eligible charges that are subject to the deductible, up to a specified out-of-pocket maximum. Once the out-of-pocket maximum has been reached, the plan will pay 100% of eligible charges.
• Preventive office visits and specialist consultations are covered with a copayment for each visit. Services to diagnose, treat, or monitor health conditions are subject to the deductible.
• Emergency room care is covered with a copayment—the deductible does not apply.
• Our network of more than 22,000 physicians and 85 hospitals.
• Out-of-network coverage is available, subject to deductible and coinsurance.
• The optional Health Reimbursement Arrangement (HRA) allows you to prefund some of your employees’ out-of-pocket medical expenses.

Advantage Saver
Tufts Health Plan Advantage Saver is our HSA-compatible option which is available as an HMO or a PPO.  The addition of a Health Savings Account (HSA) gives employees an interest-earning, tax-free fund for future health care expenses, and is administered through one of our recommended banks.  Both the employer and the member may contribute monies to the HSA, and the member may use the HSA for qualitfied medical expenses (as defined by Internal Revenue Code, Section 213(d).

As an alternative, the Advantage Saver plan can be combined with an HRA, an account funded only by the employer that is available to employees to cover eligible health expenses.

The plan design for Advantage Saver complies with federal regulations for HSA compatible health plans, including:

• Deductible minimum of $1,100 individual, $2,200 family for 2008
• Medical and pharmacy expenses track to single deductible
• Preventive care is exempt from the deductible

Advantage Saver plans feature a front-end deductible that gives your employees maximum flexibility at a price that’s competitive. The plan features:

• Deductible waived for certain preventive services, including routine office visits, routine/preventive testing, certain immunizations, and routine pre-natal and well-child care. Only a copayment is required.
• Deductible is required for all other covered services. Once the deductible (and coinsurance, if applicable for PPO plans) has been satisfied, eligible services are covered at 100%.
• HSA is available as an option with the Advantage Saver plan design.
• Our network of more than 22,000 physicians and 85 hospitals.
• For Advantage PPO Saver, out-of-network coverage is available, subject to both deductible and coinsurance.

To speak to a sales representative to find out how a Tufts Health Plan Advantage option can work for you, click here.