- CareLink Plans
- About Your Plan
- Choosing a PCP
- Frequently Asked Questions
- Health Programs
- Healthy Rewards
- Managing Costs
- Pharmacy Benefit
Not all health plans work the same way. This website will explain how CareLink plans work, so be sure to read through it carefully to understand your plan.
You can also visit mytuftshealthplan.com, our secure members-only site, to learn the details of the specific plan your employer has chosen for you. And be sure to read your Benefit Document, available at mytuftshealthplan.com, to see a complete list of your specific plan’s covered and non-covered benefits.
Knowledge is power, and knowing how your plan works will give you the power to plan for and control your out-of-pocket costs.
The overall idea behind the CareLink plans is to enable employers to offer high-quality, nationwide health care to their valuable employees (you). The CareLink plans accomplish this through a nationwide network of providers.
The CareLink Network
Tufts Health Plan and Cigna have joined together to create a nationwide network of providers. Tufts Health Plan’s network is comprised of physicians, nurse practitioners, other providers and hospitals throughout Massachusetts and Rhode Island, while Cigna’s network covers the remaining 48 states. Together, they provide access to 645,000 different doctors and 4,500 different hospitals.
With a CareLink plan, you can take comfort in knowing that no matter where in the country you are, you have access to a high-quality provider.
CareLink Advantage PPO Saver
The CareLink Advantage PPO Saver plan is a national network, high deductible health plan (HDHP) as defined by the Internal Revenue Service, and may be paired with a Health Savings Account (HSA) available through other institutions, including local banks. HSAs are accounts that can be used to pay medical expenses, while offering certain tax advantages.
You enroll in a CareLink Advantage PPO Saver plan, then set up a Health Savings Account (HSA) at any financial institution that provides HSA services. You decide how much you’d like to contribute (up to maximum IRS limits), either one-time or on an ongoing basis. The account rolls over automatically every year, and you are eligible to contribute to the account as long as you are enrolled in an HDHP compliant medical plan. And you can keep this account even if you change jobs.
You can learn more specific details about the CareLink Advantage PPO Saver medical plan by reading your Benefit Document.
Note: Information about the CareLink Saver plan has been provided for informational purposes only. While we aim to ensure that content is current, accurate and complete, Tufts Health Plan makes no representations or warranties regarding its accuracy or completeness, and the information provided should not be construed as legal or tax advice or as a recommendation of any kind. Please consult your own tax advisor or legal counsel with respect to your individual circumstances and needs.
While the goal of the CareLink plan is to provide nationwide coverage, the CareLink plan strives to do it in a cost-effective manner. One of the ways it does this is by incorporating a fee structure that may require some cost-sharing on your part. Depending on your particular plan options, this cost-sharing can be primarily in the form of two components: the deductible and the copay.
The deductible for your specific plan can vary. The amount is chosen by your employer, based on how much the entire plan costs them. We work closely with your employer to provide the best possible plan at the best possible cost for both employer and employee.
Here’s an example of how the deductible works. Let’s say your plan has a $1000 family deductible and a $500 individual deductible. You’re working in the yard, you have an accident, and you have to make a trip to the emergency room. Your maximum responsibility as an individual would be $500, not the entire $1000. Let’s say you have another accident in the same plan year. Your individual deductible of $500 has already been met, so you’re not responsible for any deductible amount.
Now let’s say your spouse needs surgery. Your family is now responsible for the remaining $500 deductible, since it’s a different individual. But now your total amount paid toward your $1000 deductible has been met. The next time anyone in your family needs medical services that are subject to the deductible, you don’t have to worry about the deductible. The deductible for the plan year has been met.
Services Not Subject to Deductible
These services are covered in full or with a copay, without your having to meet a deductible first. Generally speaking, these fall under the area of preventive care.
- Outpatient Maternity Care
- Outpatient Mental Health Care
- Outpatient Substance Abuse Services
- Preventive Blood Sugar Screening
- Preventive Cholesterol Screening
- Preventive Immunizations
- Preventive Mammograms
- Preventive Pap Smears
- Preventive Screenings (Others)
- Routine OB/Gyn Exams
- Routine Physical Exams
- Specialist Consultations
Services Subject to Dedutcible
You must meet your deductible before the plan begins payment for these services. Generally speaking, these services are rendered in the context of treating, diagnosing or testing for an illness or condition.
Diagnostic X-rays and Lab Tests
- Allergy Test
- Blood Work to Diagnose or Monitor a Condition
- Cardiac Stress Test
- Diagnostic Blood Sugar Screening
- Diagnostic Cholesterol Screening
- Diagnostic Imaging (e.g., x-ray)
- Diagnostic Mammograms
- Diagnostic Pap Smears
- Diagnostic Ultrasound
- High-Tech Imaging (e.g., MRI, CAT Scan)
- Pregnancy Test
- Throat Culture
- Upper and Lower GI
Inpatient Hospital Care and Surgery (may also require a co-payment)
- Acute Care for Illness, Injury or Maternity Services
- Day Surgery
- Emergency Room
- Mental Health and Substance Abuse
- Diagnostic Colonoscopy
- Radiation Therapy
- Setting of Bones/Casts
- Short-Term Occupational and Physical Therapy
- Sleep Studies
- Speech Therapy
- Spinal Manipulation
- Visiting Nurse
Regardless of the status of your deductible, there are some services that may also require a copay. A copay is a fee that you pay as partial payment for certain services. For instance, a visit to the doctor’s office often requires a copay. That means you pay, for example, $20 out-of-pocket as your copay.
Whether or not your deductible has been met, if a copay is required for the type of medical service you want, you are responsible for the copay. Again, the best way to control out-of-pocket costs is to read this Member Kit so you understand what you are and what you are not responsible for.
And you can always find out exactly what your specific plan covers by reading your Benefit Document or accessing your secure member account at mytuftshealthplan.com.
In some cases, coinsurance may also apply to other items. You can find the specifics of your plan, including the exact amount of your coinsurance, by reading your Benefit Document or by visiting mytuftshealthplan.com.