Medicare Advantage HMO Plans
Prescription (Rx) and Pharmacy Documents
2019 Tufts Health Plan Medicare Preferred HMO Employer Group Formulary
This document is a comprehensive formulary containing the prescription drugs covered by Tufts Health Plan Medicare Preferred Medicare Advantage HMO Group Plans.
2019 Tufts Health Plan Medicare Preferred HMO Individual Formulary
This document is a comprehensive formulary containing the prescription drugs covered by Tufts Health Plan Medicare Preferred Medicare Preferred individual HMO plans.
2019 Tufts Health Plan Medicare Preferred Prior Authorization Medical Necessity Guidelines
This document details the Tufts Health Plan Medicare Preferred Medical Necessity Guidelines. These guidelines are used by Tufts Health Plan to determine medical necessity and appropriateness of health care services for the purpose of determining coverage under the applicable health benefit plan.
2019 Tufts Health Plan Medicare Preferred Step Therapy Prior Authorization Medical Necessity Guidelines
This document details drugs that may require prior authorization or Step Therapy to be covered by Tufts Health Plan Medicare Preferred HMO and PDP plans. Prior Authorization means that your doctor, or prescriber, must first show that you have a medically necessary need for the drug before Tufts Health Plan will cover the drug cost. Step Therapy is a type of prior authorization that in most cases requires a less expensive drug, that has been proven effective for your condition, is prescribed before moving up a "step" to a more expensive drug.
Tufts Health Plan Medicare Preferred HMO & PDP Transition Process
This document details what to do if your current prescription drugs are not included in the Tufts Health Plan Medicare Preferred HMO formulary, or drug list, or are restricted in some way.
Provider Directories
2019 Tufts Medicare Preferred HMO Provider Directory with Addendum
This directory provides a list of providers in the Tufts Medicare Preferred HMO network. Please note that this directory is for members in Barnstable, Bristol, Essex, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, and Worcester counties. Updated: 7/1/19
Plan Rating Documents
Tufts Health Plan Medicare Preferred HMO Medicare Star Ratings
This document details the Star Rating given to Tufts Health Plan Medicare Preferred HMO plans. Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. For more information on plan ratings, go to www.medicare.gov.
Appeals and Grievances Documents
Fraud, Waste & Abuse
The document provides details around how Tufts Health Plan members can contact the Tufts Health Plan Fraud Hotline with questions, concerns and/or complaints related to possible wasteful, fraudulent, or abusive activity.
Tufts Health Plan Medicare Preferred HMO Appeals and Grievances Document
This document explains how to submit a complaint to Tufts Medicare Preferred in the form of an appeal or grievance.
Summary of Benefits
2019 Tufts Medicare Preferred HMO Plans | Summary of Benefits (All Counties)
This document provides a summary of the coverage and costs associated with Tufts Health Plan Medicare Preferred HMO plans in the following Massachusetts counties: Barstable, Bristol, Essex, Hampden, Hamshire, Middlesex, Norfolk, Plymouth, Suffolk and Worcester.
Legal Documents
Legal, Security, and Privacy Practices
This document details the legal, security, and privacy practices related to the Tufts Health Plan website.
Notice of Inadvertent Disclosure of Health Plan Information
This document details an inadvertent disclosure of health plan information by Tufts Health Plan.
Notice of Non-Discrimination - Tufts Health Plan Medicare Preferred HMO
Tufts Health Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
Notice of Privacy Practices
This notice describes how health information about you may be used and disclosed, and how you can get access to this information.
Evidence of Coverage
2019 Evidence of Coverage | Custom Wrap plan accompanying the Tufts Medicare Preferred HMO plan
This document provides detailed coverage information for the custom Wrap plan accompanying the Tufts Medicare Preferred HMO plan. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019.
2019 Evidence of Coverage | Tufts Medicare Preferred HMO Basic No Rx (HMO)
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Basic No Rx plan. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
2019 Evidence of Coverage | Tufts Medicare Preferred HMO Basic Rx
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Basic Rx plan. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
2019 Evidence of Coverage | Tufts Medicare Preferred HMO Prime No Rx
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime No Rx plan. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
2019 Evidence of Coverage | Tufts Medicare Preferred HMO Prime Rx
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx plan. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 06/08/2019.
2019 Evidence of Coverage | Tufts Medicare Preferred HMO Prime Rx Plus
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx Plus plan. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
2019 Evidence of Coverage | Tufts Medicare Preferred HMO Saver Rx (HMO)
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Saver Rx plan. This information covers the 2018 calendar year, from January 1, 2018 through December 31, 2018. Updated 6/8/2019.
2019 Evidence of Coverage | Tufts Medicare Preferred HMO Value No Rx (HMO)
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Value No Rx plan. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
2019 Evidence of Coverage | Tufts Medicare Preferred HMO Value Rx (HMO)
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Value Rx plan. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
2019 Evidence of Coverage | Wrap plan accompanying the Tufts Medicare Preferred HMO Plan
This document provides detailed coverage information for the Wrap plan accompanying the Tufts Medicare Preferred HMO plan. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019.
2019 Tufts Medicare Preferred Group PDP
This document provides detailed coverage information for the Tufts Medicare Preferred Group PDP plan. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
2019 Tufts Medicare Preferred Group PDP 2
This document provides detailed coverage information for the Tufts Medicare Preferred Group PDP 2 plan. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
2019 Tufts Medicare Preferred Group PDP 3
This document provides detailed coverage information for the Tufts Medicare Preferred Group PDP 3 plan. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
2019 Tufts Medicare Preferred Group PDP 4
This document provides detailed coverage information for the Tufts Medicare Preferred Group PDP 4 plan. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
2019 Tufts Medicare Preferred Group PDP Custom
This document provides detailed coverage information for the Tufts Medicare Preferred Group PDP Custom plan. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
2019 Tufts Medicare Preferred Group PDP Plus
This document provides detailed coverage information for the Tufts Medicare Preferred Group PDP Plus plan. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
2019 Tufts Medicare Preferred HMO Basic Rx Custom (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Basic Rx plan for your Employer Group. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
2019 Tufts Medicare Preferred HMO Custom Prime Rx (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx plan for your Employer Group. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
2019 Tufts Medicare Preferred HMO Custom Prime Rx II (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx II plan for your Employer Group. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
2019 Tufts Medicare Preferred HMO Custom Prime Rx Plus (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx Plus plan for your Employer Group. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
2019 Tufts Medicare Preferred HMO Harvard University (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO plan for Harvard University Employer Group. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
2019 Tufts Medicare Preferred HMO Prime Fit Rx (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Fit Rx plan for your Employer Group. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
2019 Tufts Medicare Preferred HMO Prime No Rx (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime No Rx plan for your Employer Group. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
2019 Tufts Medicare Preferred HMO Prime Rx (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx plan for your Employer Group. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
2019 Tufts Medicare Preferred HMO Prime Rx BOS (City of Boston) (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx plan for City of Boston Employer Group. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
2019 Tufts Medicare Preferred HMO Prime Rx Custom (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx plan for your Employer Group. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
2019 Tufts Medicare Preferred HMO Prime Rx Plus (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx Plus plan for your Employer Group. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
2019 Tufts Medicare Preferred HMO Prime Rx Standard (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx Standard plan for your Employer Group. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
2019 Tufts Medicare Preferred HMO Value Rx (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Value Rx plan for your Employer Group. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
Annual Notice of Change
2019 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Basic No Rx (Essex, Suffolk)
This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Basic No Rx, from 2018 to 2019, in Essex and Suffolk counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.
2019 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Basic No Rx (Worcester)
This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Basic No Rx, from 2018 to 2019, in Worcester county. It outlines how the costs and coverages for this plan have changed compared to the previous year.
2019 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Basic Rx (Essex, Suffolk)
This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Basic Rx, from 2018 to 2019, in Essex and Suffolk counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.
2019 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Basic Rx (Hampden, Hampshire)
This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Basic Rx, from 2018 to 2019, in Hampden and Hampshire counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.
2019 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Basic Rx (Other Counties)
This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Basic Rx, from 2018 to 2019, in Barstable, Bristol, Middlesex, Norfolk, and Plymouth counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.
2019 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Basic Rx (Worcester)
This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Basic Rx, from 2018 to 2019, in Worcester county. It outlines how the costs and coverages for this plan have changed compared to the previous year.
2019 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime No Rx (Essex, Suffolk)
This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Prime No Rx plan, from 2018 to 2019, in Essex and Suffolk counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.
2019 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime No Rx (Other Counties)
This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Prime No Rx plan, from 2018 to 2019, in Barstable, Bristol, Middlesex, Norfolk, and Plymouth counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.
2019 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime No Rx (Worcester)
This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Prime No Rx plan, from 2018 to 2019, in Worcester county. It outlines how the costs and coverages for this plan have changed compared to the previous year.
2019 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime Rx (Essex, Suffolk)
This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Prime Rx plan, from 2018 to 2019, in Essex and Suffolk counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.
2019 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime Rx (Hampden, Hampshire)
This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Prime Rx plan, from 2018 to 2019, in Hampden and Hampshire counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.
2019 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime Rx (Other Counties)
This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Prime Rx plan, from 2018 to 2019, in Barstable, Bristol, Middlesex, Norfolk, and Plymouth counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.
2019 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime Rx (Worcester)
This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Prime Rx plan, from 2018 to 2019, in Worcester county. It outlines how the costs and coverages for this plan have changed compared to the previous year.
2019 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime Rx Plus (Essex, Suffolk)
This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Prime Rx Plus plan, from 2018 to 2019, in Essex and Suffolk counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.
2019 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime Rx Plus (Hampden, Hampshire)
This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Prime Rx Plus plan, from 2018 to 2019, in Hampden and Hampshire counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.
2019 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime Rx Plus (Other Counties)
This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Prime Rx Plus plan, from 2018 to 2019, in Barstable, Bristol, Middlesex, Norfolk, and Plymouth counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.
2019 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Saver Rx (All Counties)
This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Prime Rx Plus plan, from 2018 to 2019, in Barstable, Bristol, Middlesex, Norfolk, and Plymouth counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.
2019 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Value No Rx (Essex, Suffolk)
This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Value No Rx, from 2018 to 2019, in Essex and Suffolk counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.
2019 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Value No Rx (Other Counties)
This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Value No Rx, from 2018 to 2019, in Barstable, Bristol, Middlesex, Norfolk, and Plymouth counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.
2019 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Value No Rx (Worcester)
This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Value No Rx, from 2018 to 2019, in Worcester county. It outlines how the costs and coverages for this plan have changed compared to the previous year.
2019 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Value Rx (Essex, Suffolk)
This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Value Rx, from 2018 to 2019, in Essex and Suffolk counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.
2019 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Value Rx (Hampden, Hampshire)
This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Value Rx, from 2018 to 2019, in Hampden and Hampshire counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.
2019 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Value Rx (Other Counties)
This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Value Rx, from 2018 to 2019, in Barstable, Bristol, Middlesex, Norfolk, and Plymouth counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.
2019 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Value Rx (Worcester)
This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Value Rx, from 2018 to 2019, in Worcester county. It outlines how the costs and coverages for this plan have changed compared to the previous year.
Medicare Supplement Plans
Policy Documents
2019 Tufts Health Plan Medicare Preferred Medicare Supplement Policy - Tufts Medicare Preferred Group Supplement 2 Plan
This document provides detailed coverage information for the Tufts Medicare Preferred Group Supplement 2 Plan. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019.
2019 Tufts Health Plan Medicare Preferred Medicare Supplement Policy - Tufts Medicare Preferred Group Supplement Plan
This document provides detailed coverage information for the Tufts Medicare Preferred Group Supplement Plan. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019.
2019 Tufts Health Plan Medicare Preferred Medicare Supplement Policy - Tufts Medicare Preferred Group Supplement Plan - Medway
This document provides detailed coverage information for the Tufts Medicare Preferred Group Supplement Plan - Medway. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019.
2019 Tufts Health Plan Medicare Preferred Medicare Supplement Policy - Tufts Medicare Preferred Premier Group Supplement Plan
This document provides detailed coverage information for the Tufts Medicare Preferred Premier Group Supplement Plan. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019.
2019 Tufts Health Plan Medicare Preferred Medicare Supplement Policy - Tufts Medicare Preferred Supplement Core Plan
This document provides detailed coverage information for the Tufts Health Plan Medicare Preferred Supplement Core plan. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019.
2019 Tufts Health Plan Medicare Preferred Medicare Supplement Policy - Tufts Medicare Preferred Supplement One Plan
This document provides detailed coverage information for the Tufts Health Plan Medicare Preferred Supplement 1 plan. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019.
Legal Documents
Legal, Security, and Privacy Practices
This document details the legal, security, and privacy practices related to the Tufts Health Plan website.
Appeals and Grievances Documents
Fraud, Waste & Abuse
The document provides details around how Tufts Health Plan members can contact the Tufts Health Plan Fraud Hotline with questions, concerns and/or complaints related to possible wasteful, fraudulent, or abusive activity.
Senior Care Options Plan (HMO-SNP)
Prescription (Rx) and Pharmacy Documents
2019 Tufts Health Plan Senior Care Options (HMO SNP) Formulary
This document is a comprehensive formulary containing the prescription drugs covered by Tufts Health Plan Senior Care Options plan.
2019 Tufts Health Plan Senior Care Options (HMO SNP) Prior Authorization Medical Necessity Guidelines
This document details the Tufts Health Plan Senior Care Options Medical Necessity Guidelines. These guidelines are used by Tufts Health Plan to determine medical necessity and appropriateness of health care services for the purpose of determining coverage under the applicable health benefit plan.
2019 Tufts Health Plan Senior Care Options (HMO SNP) Step Therapy Prior Authorization Medical Necessity Guidelines
This document details drugs that may require prior authorization or Step Therapy to be covered by Tufts Health Plan Senior Care Options plan. Prior Authorization means that your doctor, or prescriber, must first show that you have a medically necessary need for the drug before Tufts Health Plan will cover the drug cost. Step Therapy is a type of prior authorization that in most cases requires a less expensive drug, that has been proven effective for your condition, is prescribed before moving up a "step" to a more expensive drug.
Tufts Health Plan Senior Care Options Transition Process
This document details certain circumstances in which the plan can offer a temporary supply of a drug when your drug is not included in the Tufts Health Plan Senior Care Options formulary, or drug list, or is restricted in some way.
Provider Directories
2019 Tufts Health Plan Senior Care Options Provider Directory with Addendum
This directory provides a list of providers in the Tufts Health Plan Senior Care Options plan network. Updated: 7/1/19
Plan Rating Documents
Tufts Health Plan Senior Care Options Medicare Star Ratings
This document details the Star Rating given to Tufts Health Plan Senior Care Options plan. Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. For more information on plan ratings, go to www.medicare.gov.
Appeals and Grievances Documents
Fraud, Waste & Abuse
The document provides details around how Tufts Health Plan members can contact the Tufts Health Plan Fraud Hotline with questions, concerns and/or complaints related to possible wasteful, fraudulent, or abusive activity.
Tufts Health Plan Senior Care Options (HMO-SNP) Appeals and Grievances
This document explains how to submit a complaint to Tufts Medicare Preferred in the form of an appeal or grievance.
Summary of Benefits
2019 Tufts Health Plan Senior Care Options | Summary of Benefits
This document provides a summary of the coverage and costs associated with the Tufts Health Plan Senior Care Options Plan.
Legal Documents
Legal, Security, and Privacy Practices
This document details the legal, security, and privacy practices related to the Tufts Health Plan website.
Notice of Non-Discrimination - Tufts Health Plan Medicare Preferred Senior Care Options
Tufts Health Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
Notice of Privacy Practices Senior Care Options
This notice describes how health information about you may be used and disclosed, and how you can get access to this information.
Evidence of Coverage
2019 Evidence of Coverage | Tufts Health Plan Senior Care Options (HMO-SNP)
This document provides detailed coverage information for the Tufts Health Plan Senior Care Options plan. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019. Updated 6/8/2019.
Annual Notice of Change
2019 Annual Notice of Change | Tufts Health Plan Senior Care Options (HMO SNP)
This documents details the year-over-year changes to the Tufts Health Plan Senior Care Options, from 2018 to 2019. It outlines how the costs and coverages for this plan have changed compared to the previous year.
Prescription Drug Plan (PDP)
Prescription (Rx) and Pharmacy Documents
2019 Tufts Health Plan Medicare Preferred Prior Authorization Medical Necessity Guidelines
This document details the Tufts Health Plan Medicare Preferred Medical Necessity Guidelines. These guidelines are used by Tufts Health Plan to determine medical necessity and appropriateness of health care services for the purpose of determining coverage under the applicable health benefit plan.
2019 Tufts Health Plan Medicare Preferred Step Therapy Prior Authorization Medical Necessity Guidelines
This document details drugs that may require prior authorization or Step Therapy to be covered by Tufts Health Plan Medicare Preferred HMO and PDP plans. Prior Authorization means that your doctor, or prescriber, must first show that you have a medically necessary need for the drug before Tufts Health Plan will cover the drug cost. Step Therapy is a type of prior authorization that in most cases requires a less expensive drug, that has been proven effective for your condition, is prescribed before moving up a "step" to a more expensive drug.
Tufts Health Plan Medicare Preferred HMO & PDP Transition Process
This document details what to do if your current prescription drugs are not included in the Tufts Health Plan Medicare Preferred HMO formulary, or drug list, or are restricted in some way.
Provider Directories
2019 Tufts Medicare Preferred PDP Employer Group Pharmacy Directory
This directory provides a list of providers and pharmacies in the Tufts Health Plan Medicare Preferred Group Retiree Prescription Drug Plan network.
Appeals and Grievances Documents
Fraud, Waste & Abuse
The document provides details around how Tufts Health Plan members can contact the Tufts Health Plan Fraud Hotline with questions, concerns and/or complaints related to possible wasteful, fraudulent, or abusive activity.
Legal Documents
2019 Evidence of Coverage | Custom Wrap plan accompanying the Tufts Medicare Preferred PDP plan
This document provides detailed coverage information for the custom Wrap plan accompanying the Tufts Medicare Preferred PDP plan. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019.
2019 Evidence of Coverage | Wrap plan accompanying the Tufts Medicare Preferred PDP Plan
This document provides detailed coverage information for the Wrap plan accompanying the Tufts Medicare Preferred PDP plan. This information covers the 2019 calendar year, from January 1, 2019 through December 31, 2019.
Legal, Security, and Privacy Practices
This document details the legal, security, and privacy practices related to the Tufts Health Plan website.