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Click below to download enrollment materials for:

Enrollment Forms:

2008 HMO Enrollment Form (Health Maintenance Organization 264K)

2008 PPO Enrollment Form (Preferred Provider Organization 160K)

2008 PFFS Enrollment Form (Private Fee-for-Service 412K)

Prescription Drug Forms:

Universal Pharmacy Form (24K)

Coverage Determination Request Form (1.6MB)

HMO Caremark Mail Order Form (617K)

PPO Caremark Mail Order Form (616K)

PFFS Caremark Mail Order Form (620K)

Plan Information:

2008 HMO Summary of Benefits (5.8MB)

2008 PPO Summary of Benefits (5.8MB)

2008 PFFS Summary of Benefits (5.8MB)

2008 HMO Basic Evidence Of Coverage (2.3MB)

2008 HMO Value Evidence Of Coverage (2.1MB)

2008 HMO Prime Evidence Of Coverage (2.1MB)

2008 PPO Evidence Of Coverage (2.3MB)

2008 PFFS Basic Evidence Of Coverage (752K)

2008 PFFS Prime Evidence Of Coverage (2.1MB)

HMO Provider Directory (10.6 MB)

PPO Provider Directory (5.9 MB)

Additional Information:

Preferred Extras (224K)

H2256-2008-56R1 9-28-07 H2229-2008-44R1 9-28-07 H3057-2008-103R1 9-28-07

This document was last modified: 9-28-07

Link to Tufts Health Plan

The Medicare Advantage contract between Tufts Health Plan and the Centers for Medicare & Medicaid Services (CMS) is valid for one calendar year. The benefits, premiums, copayments and service area offered by Tufts Health Plan are subject to change on an annual basis. Please contact Tufts Health Plan Medicare Preferred for details. Tufts Health Plan Medicare Preferred is a medicare advantage organization that contracts with the Federal Government.

© 2007 Tufts Associated Health Plans, Inc. All rights reserved.