Important Plan Changes for Tufts Health Plan Senior Care Options (HMO-SNP) Members
This article will be updated with new information as it becomes available. Last updated 7/29/21. The Massachusetts state of emergency will no longer be in place as of June 15, 2021. Some policy changes have been reinstated, effective August 7, 2021.
At Tufts Health Plan, we are committed to making sure you have access to the health care services you need during the COVID-19 pandemic. As part of that commitment, we made some changes at the outset of the pandemic to help you take full advantage of the coverage and savings your plan has to offer during this uncertain time.
COVID vaccine distribution for residents of the Commonwealth continues to be led by the State government. For details and the most up-to-date information on vaccine distribution, please visit www.mass.gov/covid-19-vaccine-in-massachusetts. Members can get the vaccine at any designated location near them at no cost.
Benefit changes are subject to regulatory requirements and approval. All changes made due to the COVID-19 pandemic are available until the end of the public health emergency or 12/31/21, whichever is earlier.
What is changing on August 7, 2021?
- Effective August 7, 2021, prior authorization requirements are being re-instated for non-urgent/emergent new diagnosis and treatment of COVID-19 or the risk of COVID-19 contraction, as applicable.
OTC Allowance – Balance Extension and Other Changes
- Beginning July 1, 2021, you can use your DailyCare+ card to purchase healthy food items at the same locations where the card is currently accepted. Your DailyCare+ card spending amount also increased to $40 per calendar quarter. See a full list of covered healthy food items, or call Member Services at 1-855-670-5934 (TTY: 711) for more details.
- 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).
- You can refill prescription medication early without waiting to finish your current fill.
- You can 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.
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.
- 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).
Out of country travel
Members are covered for urgent and/or emergent services only when traveling outside of the United States and its territories. Coronavirus tests are only covered or reimbursed if they are medically necessary. Diagnostic coronavirus testing required as a condition of travel inside or outside of the United States and its territories is not covered.