Tufts Health Plan Insurance Company

Frequently Asked Questions

Q: Is Tufts Health a nonprofit organization?

A: Tufts Health Plan operates as a nonprofit health insurer, choosing member care over profit. As a nonprofit, They put people before profit. This means more resources can go toward better plans and more affordable services.

Members benefit from a focus on quality care rather than the bottom line. Being a nonprofit is central to the Tufts identity. It drives their mission to guide and empower healthier lives for communities across New England

Q: What states does Tufts cover?

A: Tufts Health Plan primarily serves Massachusetts, Rhode Island, and New Hampshire. Its standard provider network covers doctors, specialists, and hospitals across all three states. Members in Connecticut, Maine, Vermont, and New York can also access some extended coverage.

Employers based in Massachusetts and Rhode Island can also extend coverage to employees living in other states. Tufts Health Plan’s partnership with Cigna makes this possible.

Q: How is Tufts Health care rated compared to other health insurers?

A: Tufts Health Plan has consistently ranked among the top health plans in the country. The NCQA rates Tufts Health Plan’s commercial HMO/PPO plan #1 in America. The NCQA has also awarded Tufts a top rating for its Medicaid plan. Tufts has further earned NCQA recognition for its Wellness & Health Promotion program.

Q: Does Tufts Health Plan require a referral to see a specialist?

A: It depends on which type of plan you have. HMO and EPO plans require a referral from your primary care provider before seeing a specialist. POS plans require a referral for in-network benefits. PPO plans generally do not require a referral.

If you are unsure whether your plan requires a referral, call the Member Services number on your member ID card.

Q: Do Tufts Health care plans require prior authorization for certain services?

A: Yes. Prior authorization means Tufts Health Plan must approve certain procedures or services before you receive them. Your in-network provider is responsible for submitting the prior authorization request on your behalf.

Tufts reviews each request against up-to-date clinical and medical guidelines. This helps make sure members get the right level of care, at the right time, and in the right setting.

Q: Does Tufts Health insurance cover mental health and therapy services?

A: Yes, all Tufts Health Plan plans include mental health benefits. Coverage typically includes therapy services provided by credentialed mental health professionals using evidence-based treatment modalities.

Seeing an in-network therapist generally costs around $40 per visit. For out-of-network care, you will pay a share of the total cost instead of a fixed amount. Tufts excludes services like life coaching, aromatherapy, reiki, and non-medically necessary acupuncture from coverage.

Q: Who is the parent company of Tufts Health?

A: Tufts Health Plan is part of Point32Health, a nonprofit organization. Tufts Health Plan and Harvard Pilgrim Health Care came together in 2021, forming Point32Health. The name Point32Health reflects the 32 points on a compass. Together, the two brands serve over 2.4 million members across New England.