Non-Union

On this Page

• How the Plan Works
• Urgent and Emergency Care
• Preventive Care
• Outpatient Care
• Inpatient Care
• Prescriptions

How the Plan Works

To receive the highest level of coverage, you must choose a HUGHP primary care provider (PCP) and obtain your health care services and supplies from covered providers who participate in your health plan’s provider network.

Primary Care Provider 

You must choose a primary care provider (PCP) for you and each member on the plan from the HUGHP network of participating providers. To find a HUGHP PCP, visit our Find a Doctor webpage or call Member Services.

POS members can select an out-of-network primary care physician but will have higher out-of-pocket costs. Review your Benefit Description for details.

Service Area

The plan’s service area includes all cities and towns in the Commonwealth of Massachusetts. To receive the highest level of benefits, any additional follow-up care must be arranged by your PCP.
Note: Urgent and emergency services are covered at the in-network level of benefits when outside the service area (see urgent and emergency care for details).

Deductible

This is the cost you pay out-of-pocket before you can receive coverage for some benefits under this plan.

Coinsurance

This is the percentage you may have to pay for a covered service after the deductible is met.

Out-of-Pocket Maximum

This is the most that you could pay during a plan year for deductibles, copayments, and coinsurance for covered services.
The out-of-network out-of-pocket maximum does not protect you from balance billing.

Referrals

Most visits with a specialist will require a referral from your primary care provider before your appointment. Otherwise, you will pay all out-of-network costs associated with the appointment. If the specialist you were referred to wants you to see another provider, contact your primary care physician to get a referral for any other visits. 

POS members have the flexibility to seek care without a referral and to see providers not in the HUGHP network. If you use your out-of-network benefits, your out-of-pocket costs will be higher.

Services that Do Not Require a Referral

• Behavioral Health outpatient office visits
• Chiropractor
• Emergency medical care
• Nutrition counseling
• OB/GYN
• Ophthalmologist/Optometrist for routine eye exams only (requires a referral for a diagnostic or sick visit)

Out-of-Network Providers Self-Referred

POS  members have the option of managing their own health care and receiving health care and services from providers who are not in the Harvard University Group Health Plan network. If you decide to use your out-of-network benefits, your out-of-pocket costs will be higher, and you may also be balance billed for the difference between the actual charges and the Blue Cross Blue Shield of Massachusetts allowed amount for covered services.

Claims Process
If you elect to use your out-of-network benefits, you may have to pay for covered services rendered and file for reimbursement using this Blue Cross Blue Shield of Massachusetts claim form. Once you have met your deductible, you will be reimbursed for covered services minus your applicable coinsurance. You can view the status of your claim at Blue Cross Blue Shield MyBlue. You will need to create a secured login to view the status of your claim. Please note that it can take up to 60 days to process a claim. Learn more about the claims process.

Urgent and Emergency Care

Emergency Room Services

A suspected heart attack, stroke, poisoning, and loss of consciousness are examples of medical emergencies. Go directly to the nearest medical facility or call 911 (or the local emergency phone number).
In-Network: copayment applies. This fee is waived if you’re admitted to the hospital or for an observation stay.
Out-of-Network: copayment applies. Deductible does not apply. This fee is waived if you’re admitted to the hospital or for an observation stay. 

Urgent Care 

A sprained ankle, an earache, and a fever are examples of illnesses and injuries that may require urgent care.
In-Network: The copayment you are charged will depend on where you are seen. Contact your primary care physician within 48 hours of receiving urgent care.
Out-of-Network: Same as PCP/plan approved.

Well Connection: Telemedicine Video Visits

Receive urgent medical and behavioral health care using your smartphone, tablet, or computer. No referral is needed. Providers are accessible 24 hours a day, 7 days a week, 365 days a year for non-emergency care.
In-Network: copayment applies. Must use a network Well Connection provider; your appointments would be covered with the applicable office visit copay. You may be asked to provide your credit card number to pay for your copay, just as you would at a doctor’s office.
Out-of-Network: coinsurance applies.

Preventive Care

Routine Exams

For annual physicals, eye exams for eyeglasses, hearing exams, and GYN exams. One per calendar year.
In-Network: $0 copayment. 
Out-of-Network: coinsurance applies.

Outpatient Care

Medical and Specialty Office Visits

In-Network: copayment applies. 
Out-of-Network: coinsurance applies.

Mental Health or Substance Use Treatment

In-Network: copayment applies.
Out-of-Network: coinsurance applies - no deductible.  In addition to your coinsurance, you may be responsible for any balance of charges above the allowed charge.

Chiropractor Office Visits

Up to 18 visits per calendar year.
In-Network: copayment applies. 
Out-of-Network: coinsurance applies.

Physical and Occupational

Up to 100 visits per calendar year.
In-Network: copayment applies. 
Out-of-Network: coinsurance applies.

Diagnostic X-Rays and Lab Tests

In-Network: $0 copayment. 
Out-of-Network: coinsurance applies.

CT Scans, MRIs, PET Scans, and Nuclear Cardiac Imaging Tests

In-Network: coinsurance applies.
Out-of-Network: coinsurance applies.

Surgery and Related Anesthesia

• Office or health center services: In-Network: copayment applies; Out-of-Network: coinsurance applies.
• Ambulatory surgical facility, hospital outpatient department, or surgical day care unit: In-Network: coinsurance applies after deductible; Out-of-Network: coinsurance applies after deductible.

Inpatient Care

General or Chronic Disease Hospital Care

In-Network: coinsurance applies after deductible; Out-of-Network: coinsurance applies.

Mental Health Substance Use Facility Care

In-Network: coinsurance applies after deductible; Out-of-Network: coinsurance applies.

Prescriptions (view cost tiers)

You can fill most prescription drugs in two ways:

1. A Participating Pharmacy

Copayment at a participating pharmacy for up to a 30-day supply:

• Tier 1: Most generic drugs - $
• Tier 2: Preferred brand-name drugs - $$
• Tier 3: Non-preferred brand-name drugs - $$$

2. Mail Order Through Express Scripts

Discounted copayments through Express Scripts mail order for a 90-day supply:

• Tier 1: Most generic drugs - $
• Tier 2: Preferred brand-name drugs - $$
• Tier 3: Non-preferred brand-name drugs - $$$

On this Page

• How the Plan Works
• Urgent and Emergency Care
• Preventive Care
• Outpatient Care
• Inpatient Care
• Prescriptions

How the Plan Works

To receive the highest level of coverage, you must choose a HUGHP primary care provider (PCP) and obtain your health care services and supplies from covered providers who participate in your health plan’s provider network.

Primary Care Provider 

You must choose a primary care provider (PCP) for you and each member on the plan from the HUGHP network of participating providers. To find a HUGHP PCP, visit our Find a Doctor webpage or call Member Services at 617-495-2008.

POS Plus members can select an out-of-network primary care physician but will have higher out-of-pocket costs. Review your Benefit Description for details.

Service Area

The plan’s service area includes all cities and towns in the Commonwealth of Massachusetts. To receive the highest level of benefits, care must be arranged by your PCP.
Note: Urgent and emergency services are covered at the in-network level of benefits when outside the service area (see urgent and emergency care for details).

Deductible

This is the cost you pay out-of-pocket before you can receive coverage for some benefits under this plan.

Coinsurance

This is the percentage you may have to pay for a covered service after the deductible is met.

Out-of-Pocket Maximum

This is the most that you could pay during a plan year for deductibles, copayments, and coinsurance for covered services.
The out-of-network out-of-pocket maximum does not protect you from balance billing.

Referrals

Most visits with a specialist will require a referral from your primary care provider before your appointment. Otherwise, services will be covered as out-of-network. If the specialist you were referred to wants you to see another provider, contact your primary care physician to get a referral for any other visits. 

POS Plus members have the flexibility to seek care without a referral and to see providers not in the HUGHP network. If you use your out-of-network benefits, your out-of-pocket costs will be higher.

Services that Do Not Require a Referral

• Behavioral Health outpatient office visits
• Chiropractor
• Emergency medical care
• Nutrition counseling
• OB/GYN
• Ophthalmologist/Optometrist for routine eye exams only (requires a referral for a diagnostic or sick visit)

Out-of-Network Providers Self-Referred

POS Plus members have the option of managing their own health care and receiving services from providers who are not in the Harvard University Group Health Plan network. Your out-of-pocket costs will be higher when you self-refer and/or see out-of-network providers. Additionally, you may also be balance billed for the difference between the provider’s actual charge and the Blue Cross Blue Shield of Massachusetts allowed amount for covered services.

Claims Process
If you elect to use your out-of-network benefits, you may have to pay for covered services rendered and file for reimbursement using this Blue Cross Blue Shield of Massachusetts claim form. Once you have met your deductible, you will be reimbursed for covered services minus your applicable coinsurance. You can view the status of your claim at Blue Cross Blue Shield MyBlue. You will need to create a secured login to view the status of your claim. Please note that it can take up to 60 days to process a claim. Learn more about the claims process.

Urgent and Emergency Care

Emergency Room Services

A suspected heart attack, stroke, poisoning, and loss of consciousness are examples of medical emergencies. Go directly to the nearest medical facility or call 911 (or the local emergency phone number).
In-Network: copayment applies. This fee is waived if you’re admitted to the hospital or for an observation stay.
Out-of-Network: copayment applies. Deductible does not apply. This fee is waived if you’re admitted to the hospital or for an observation stay. 

Urgent Care 

A sprained ankle, an earache, and a fever are examples of illnesses and injuries that may require urgent care.
In-Network: copayment applies. Contact your primary care physician within 48 hours of receiving urgent care. 
Out-of-Network: copayment when outside of the service area; otherwise, coinsurance applies.

Well Connection: Telemedicine Video Visits

Receive urgent medical and behavioral health care using your smartphone, tablet, or computer. No referral is needed. Providers are accessible 24 hours a day, 7 days a week, 365 days a year for non-emergency care.
In-Network: copayment applies. Must use a network provider for the highest level of benefits; your appointments would be covered with applicable office visit copay. You may be asked to provide your credit card number to pay for your copay, just as you would at a doctor’s office.
Out-of-Network: coinsurance applies.

Preventive Care

Routine Exams

For annual physicals, eye exams for eyeglasses, hearing exams, and GYN exams. One per calendar year.
In-Network: $0 copayment. 
Out-of-Network: coinsurance applies.

Outpatient Care

Medical and Specialty Office Visits

In-Network: copayment applies. 
Out-of-Network: coinsurance applies.

Mental Health or Substance Use Treatment

In-Network: copayment applies. 
Out-of-Network: coinsurance applies - no deductible.  In addition to your coinsurance, you may be responsible for any balance of charges above the allowed charge.

Chiropractor Office Visits

Up to 18 visits per calendar year.
In-Network: copayment applies. 
Out-of-Network: coinsurance applies.

Physical and Occupational

Up to 100 visits per calendar year.
In-Network: copayment applies. 
Out-of-Network: coinsurance applies.

Diagnostic X-Rays and Lab Tests, Including CT Scans, MRIs, PET Scans, and Nuclear Cardiac Imaging Tests

In-Network: $0 copayment. 
Out-of-Network: coinsurance applies.

Surgery and Related Anesthesia

• Office or health center services: In-Network: copayment applies; Out-of-Network: coinsurance applies.
• Ambulatory surgical facility, hospital outpatient department, or surgical day care unit: In-Network: $0 copayment; Out-of-Network: coinsurance applies.

Inpatient Care

General or Chronic Disease Hospital Care

In-Network: $0 copayment; Out-of-Network: coinsurance applies.

Mental Health Substance Use Facility Care

In-Network: $0 copayment; Out-of-Network: coinsurance applies.

Prescriptions (view cost tiers)

You can fill most prescription drugs in two ways:

1. A Participating Pharmacy

Copayment at a participating pharmacy for up to a 30-day supply:

• Tier 1: Most generic drugs - $
• Tier 2: Preferred brand-name drugs - $$
• Tier 3: Non-preferred brand-name drugs - $$$

2. Mail Order Through Express Scripts

Discounted copayments through Express Scripts mail order for a 90-day supply:

• Tier 1: Most generic drugs - $
• Tier 2: Preferred brand-name drugs - $$
• Tier 3: Non-preferred brand-name drugs - $$$