Tufts Private Insurance: What You Need To Know

Tufts Health Plan was a Massachusetts-based non-profit health insurance company, which merged with Harvard Pilgrim Health Care in 2021 to become the second-largest health insurer in Massachusetts. The company offers a range of health insurance plans, including Medicare, Medicaid, and private health insurance for students. All Tufts students are required by Massachusetts state law to have health insurance and can either enrol in the student health insurance plan or waive it by providing proof of comparable private insurance. This paragraph introduces the topic of Tufts private insurance, including its history, offerings, and requirements for students.

Students with private insurance

All students at Tufts, both undergraduates and graduates, are required by Massachusetts state law to have health insurance. Students who are enrolled half-time or more are automatically billed and enrolled in the student health insurance plan. However, if a student is covered by a separate policy, they can waive the insurance charge by completing the Health Insurance Waiver on their SIS account. This waiver must be completed annually between June 1st and July 31st. It's important to note that this waiver does not exempt undergraduate students from the mandatory Health and Wellness fee.

For students with private insurance, it is necessary to ensure that the policy is through a U.S.-based insurance company and offers comparable coverage to the student health plan. The private insurance must be comparable to waive the insurance charge. Students with private insurance should contact their insurance company to understand their specific benefits and coverage. Certain services at Tufts, such as lab tests, immunizations, and orthopedic visits, will require the use of the student's private insurance.

The billing process for private health insurance involves charges being listed as "Health Service charge" on the student's tuition bill, available for review on their SIS account within 1-2 weeks. To obtain reimbursement from their insurance company, students can download and print their Health Service Statement from the Patient Portal. Additionally, students can contact their insurance company to understand their mental health coverage, yearly deductible, and any limits to their coverage.

It is worth noting that Tufts has a separate insurance coordinator who can be contacted for more information regarding health insurance: [email protected]. Additionally, students can refer to the Billing Information or contact the Business Office for clarification on how specific services are billed to the insurance company or the patient.

Mental health coverage

Tufts Health Plan offers mental health coverage for its members. The coverage includes a range of mental health treatments and options, including inpatient services when medically necessary. However, the specific coverage may vary depending on the member's plan.

Tufts Health Plan covers mental health treatments such as therapy and counselling. To determine the extent of coverage, members should refer to their specific plan documents or contact member services. The cost per session may depend on the plan specifics and the provider rate. Most Tufts Health Plan insurance plans have a copayment, which is a preset amount that members pay for covered health services at the time of receiving care.

Tufts Health Plan also covers substance use and addiction treatment, including drug and alcohol rehab. Outpatient care services covered by Tufts Health Plan include substance abuse treatment, medication, evaluation, and monitoring. Members can also receive an outpatient diagnosis and treatment for co-occurring disorders such as depression, anxiety, and eating disorders.

In addition to outpatient services, Tufts Health Plan provides coverage for a range of medically necessary inpatient and intermediate services. This includes inpatient medical detox, acute residential treatment, and partial hospitalization programs. Tufts Health Plan also offers intensive outpatient programs, medication management, and medication-assisted treatment (including methadone and Suboxone).

To verify mental health coverage, members can refer to their plan documents or contact member services using the phone numbers provided on their insurance cards.

Clinical laboratory testing

Students with private insurance must ensure that their insurance company covers laboratory testing. If they are covered by a separate policy, it must be through a U.S.-based insurance company and comparable to the student health plan. Students can contact their insurance company to confirm whether Quest is an "in-network" clinical laboratory provider. If Quest is not in-network, students should request a list of in-network providers in the area from their insurance company and contact the Business Office for further assistance if needed.

For laboratory tests performed at the Health Services Clinical Laboratory, the charges are billed to the student's SIS account. To protect confidentiality, any fees applied to the Tuition Bill will only be listed as a "Health Service charge" with no further details. Once the charge appears on the SIS account, students can access and print their Health Service Statement from the Patient Portal to submit to their insurance company for reimbursement. Alternatively, students can pay directly at the Bursar's Office to avoid receiving a Tuition Bill.

The Clinical Pathology Laboratory at Tufts University supports the diagnosis of diseases through advanced laboratory testing of blood and other bodily fluids, tissues, and microscopic evaluation of individual cells. The laboratory is equipped with state-of-the-art equipment, and all tests are conducted by qualified and highly trained medical technologists with extensive experience in human and veterinary clinical pathology. The laboratory offers a range of routine clinical pathology diagnostic tests, including hematology, clinical chemistry, coagulation, fluid and cytology analysis, and fecal analysis.

Medicare Advantage plans

Tufts Health Plan was a Massachusetts-based non-profit health insurance company that merged with Harvard Pilgrim Health Care in 2021 to become the second-largest health insurer in Massachusetts. Tufts offers a range of Medicare Advantage plans, which are also known as Medicare Part C plans.

Tufts Medicare Advantage Plans provide medical and prescription drug coverage (Medicare Part D) beyond Original Medicare (Medicare Parts A & B). Tufts offers both Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) Medicare Advantage plans.

Tufts Medicare Preferred Access (PPO) Plan

The Tufts Medicare Preferred Access (PPO) Plan offers flexibility to choose from a wide range of doctors nationwide, and there is no need for referrals to see a specialist. This plan includes a $1,500 dental flex advantage spending card and $520 annually towards over-the-counter items. It has a $0 medical deductible, prescription drug coverage included, a $350 annual wellness allowance, and a $150 annual eyewear benefit.

Tufts Medicare Preferred HMO Plans

Tufts offers several Medicare Advantage HMO plans, including the Smart Saver Rx, Saver Rx, Basic No Rx, Basic Rx, Value No Rx, Value Rx, Prime No Rx, Prime Rx, and Prime Rx Plus plans. These plans vary in terms of medical deductibles, prescription drug coverage, annual wellness allowances, and eyewear benefits. For example, the 2025 Tufts Medicare Preferred HMO Saver Rx plan includes a $0 medical deductible, prescription drug coverage, a $300 annual wellness allowance, and a $250 annual eyewear benefit with an EyeMed provider.

Tufts Medicare Advantage Plans provide access to thousands of doctors, specialists, and hospitals, along with more benefits and financial security than Original Medicare alone. To find out more about specific plan offerings and pricing in your area, you can visit the Tufts Health Plan website and enter your zip code.

Medicare Supplement plans

Tufts Health Plan was a Massachusetts-based non-profit health insurance company that merged with Harvard Pilgrim Health Care in 2021. Tufts Health Plan offers Medicare Supplement plans to fill in the gaps in Original Medicare coverage, which can help prevent unexpected medical costs.

Tufts Medicare Supplement plans allow you to continue seeing any doctor that accepts Original Medicare, while also providing access to thousands of doctors, specialists, and hospitals in their network.

Tufts offers various Medicare Supplement plans, including the 2024 Tufts Medicare Preferred Supplement 1, 1A, and Core plans. These plans have different benefit periods and deductibles associated with Medicare Parts A and B. For example, the 2024 Tufts Medicare Preferred Supplement Core plan has a $1,632 per benefit period and a $240 annual deductible for Medicare Part B.

Individuals who join a Tufts Medicare Preferred Supplement plan may be eligible for a discounted premium if they are 65 or older and join within six months of acquiring Medicare Part B coverage. The discount is offered for the first 36 months of the plan and ranges from 15% to 5% off the premium.

Tufts Health Plan also offers other Medicare options, such as Medicare Advantage Plans, which provide more benefits and financial security than Original Medicare alone. Additionally, they have Senior Care Options (HMO-SNP) plans, which offer more benefits than Original Medicare at no cost for those who qualify.

Frequently asked questions