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Important Plan Changes for Tufts Health Plan Senior Care Options (HMO-SNP) Members

At Tufts Health Plan, we are committed to making sure you have access to the health care services you need during the coronavirus (COVID-19) outbreak. As part of that commitment, we have made some changes to help you take full advantage of the coverage and savings your plan has to offer during this uncertain time.

We will re-evaluate all COVID-19 related coverage changes and may extend or expand them as necessary if the public health emergency continues into 2021. Benefit changes are subject to regulatory requirements and approval.

OTC Allowance – Balance Extension

  • You can apply your OTC balance to the purchase of a mask or an oxygen sensing device (oximeter). If you have lung disease or early signs of COVID-19, having an oximeter that measures your pulse and oxygen level in your blood can provide important information for your doctor.
  • Don’t want to go to the store to shop? You can now also use your Instant Saving card and DailyCare+ card allowances to order eligible items online or over the phone through NationsOTC. Order items for free delivery to your home by logging onto the NationsOTC website or by calling 1-833-746-7682 (TTY: 711).

Prescription Refills

  • You can refill prescription medication early without waiting to finish your current fill.
  • You can also refill up to a 90-day supply, to the extent consistent with clinical guidelines.
  • Controlled substances are excluded from this policy (subject to CMS rules).

Coverage for Care Related to Coronavirus

  • As you know, health care coverage is provided to Tufts Health Plan Senior Care Options (HMO-SNP) members at no cost. That means any medically necessary testing, counseling, or treatment related to the coronavirus is covered for $0. This coverage applies at in-network providers, urgent care centers, emergency rooms and other facilities, and at out-of-network providers in the event you cannot easily find an in-network provider to provide timely services.

Removal of Prior Authorizations

  • We are removing prior authorization requirements related to new diagnoses and treatments of the coronavirus or the risk of coronavirus contraction. This will make it easier for you to get the care you need without delay.

Removal of Referrals

  • You are not required to get a referral from your Primary Care Physician (PCP) for in-network services. A referral is also not required for out-of-network services related to the coronavirus, inpatient care, post-acute care, or when receiving primary care or outpatient behavioral health services.

Telehealth/Telemedicine Services

  • Need a doctor’s appointment but don’t want to leave home? Ask your PCP or other provider if they would be able to schedule a telehealth/telemedicine appointment. With a telehealth/telemedicine appointment, you are able to use your smartphone or computer for video consultations. This helps you avoid going into your doctor’s office where you could come into contact with the coronavirus. In-network telehealth/telemedicine services are provided to Tufts Health Plan Senior Care Options members at no cost (out-of-network telehealth/telemedicine services are not covered). 

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