Members present their Tufts Health Plan ID card when seeking services, and pay the appropriate copayment. Services are subject to deductibles and coinsurance. Members must complete and submit claim forms to Tufts Health Plan. In an emergency that requires hospitalization, members must call Customer Relations by the next business day. If a member does not initiate Utilization Review, there may be considerable benefit reductions.
Emergency care is covered at the in-network level.
If you stay in the Tufts Health Plan network and pay only a small copayment, tell your doctor so that he or she can send you to a network provider. Doctors are under agreement to use a network lab whenever possible. If you do receive a bill, simply forward it to Tufts Health Plan, P.O. Box 557, Rockland, MA 02370. While most deductibles and benefit maximums are reset at the beginning of the calendar year, your Summary Plan Description details your employer's plan limits. While doctors are under agreement to use network services whenever possible, there may be instances when a service is not available within the Tufts Health Plan network.