Tufts Health Plan and Harvard Pilgrim Health Care officially come together
Frequently Asked Questions
The new organization will strive to create a preeminent, nonprofit regional health services organization focused on improving affordability, increasing access to high quality health care, and enhancing member experience.
The newly combined organization serves close to 2.4 million members in Massachusetts, Maine, Connecticut, New Hampshire and Rhode Island; offering employer-sponsored plans, Medicare and Medicaid plans, Qualified Health Plans, and plans for those who are dually eligible for Medicare and Medicaid.
Below are frequently asked questions which will be updated as new information becomes available. Please check back here for most recent updates.
The combination of Tufts Health Plan and Harvard Pilgrim brings together two highly regarded health care companies that are known for delivering excellence in quality, service, innovation and commitment to the community. By leveraging the individual strengths and best-in-class capabilities of our organizations, the newly combined organization seeks to improve the health of our communities and redefine the role a health plan plays in expanding access, containing costs, and working toward better health outcomes for the customers and the communities we serve.
Thomas Croswell is the chief executive officer, and Michael Carson is president of the new organization and oversees the commercial, Medicare, and Medicaid/government subsidized lines of business. The following individuals are leading and supporting the Commercial business for the new, combined organization:
- Head of Commercial Business: Beth Roberts
- Head of Senior Programs/Medicare: Patty Blake
- Head of Public Plans: Jean Yang
- President of Health Plans, Inc.: Deb Hodges
- Head of Business Diversity: Juan Lopera
- Head of Actuarial: Tracey Carter
We hope to share additional appointments with you in Q2 2021.
While our companies have combined, the new official name of the parent company is in development, as are discussions of how that new name will be used going forward. Harvard Pilgrim and Tufts Health Plan will continue to be in market with our heritage brands and products for years. Integration of products and systems takes time, and our first priority is a seamless transition for our broker partners and customers.
Our heritage brands and products will remain in the market for a period of time as we transition technologies and processes. The benefits, programs and services our members currently rely on do not change. As transitions are planned and poised to occur, we are committed to clear, concise and consistent messages with all our stakeholders to maximize the sharing of information and minimize confusion.
You will see a lot of coordination as both product lines remain active in the market for 2021, and you’ll experience a consistent rating experience as our underwriting teams collaborate. We are also looking at all our offerings to identify services and features we can leverage across both portfolios to make products even more competitive.
Our promise to you is to minimize disruption, add value for you and your customers, and continue to be a good partner.
We have jointly identified synergy savings, and over the next five years, we expect over $100 million dollars in savings. We intend to use half of the savings to reduce premium increases; the remainder will be used to invest in access, quality, and addressing health equity issues as well as improving member experiences.
As we have stated, our goal is to minimize any disruption resulting from the combination. There will be little to no immediate change in operations for the markets in which only Tufts Health Plan or Harvard Pilgrim does business.
Core to our mutual values, business diversity will continue to be a central mission for our combined organizations. Furthermore, we believe there is enormous value in integrating the use of demographic data and knowledge of the social determinants of health into the development of our products and programs. With this in place, we’ll bring health equity programs and culturally oriented health interventions that will better address social service needs and achieve equitable outcomes for the diverse communities we serve. We are committed to inclusion and diversity as important values of this new organization.
New Business Quotes and Renewals
Brokers should continue to request new business quotes and renewals as they always have for business with Harvard Pilgrim and Tufts Health Plan.
Both Harvard Pilgrim and Tufts Health Plan will honor all quotes and renewals that have been delivered to brokers and accounts.
Both Harvard Pilgrim and Tufts Health Plan will honor all quotes and renewals that have been delivered to brokers and accounts.
There will be no change to any online access for small group business through 2022. Our new organization is committed to building the most robust and cutting-edge tools for our brokers to manage their clients’ health insurance needs through our portal. You can expect a new portal mid-year 2021 for accessing all your Harvard Pilgrim small group business. Continuing to improve the ease of doing business with our organization is a priority for our teams.
Yes, Health Plans, Inc., is in our family of companies, and the third-party administrator business is a unique offering that we support.
Brokers and consultants will submit the RFPs to either or both organizations, and we will coordinate our responses to ensure we are meeting the needs of the prospective client.
There will be no change to the processes for selling through intermediaries in the near term.
In Massachusetts, the current Tufts Health Plan and Harvard Pilgrim sales and account representatives will stay the same in the near term. If or when there are any changes, you will be notified well in advance.
There are no immediate changes planned for the regional sales teams in New Hampshire, Maine, Connecticut or Rhode Island. The sole exception is for Tufts Health Freedom Plan in New Hampshire, which has been sold to UnitedHealthcare in connection with the combination. Please see the separate communications regarding the sale or visit the Tufts Health Freedom Plan website for more information.
There will be no changes to the broker service model for either organization throughout 2021. As always, we will be evaluating our service models to ensure we are bringing you the most efficient resources and support to manage your clients.
Service for Harvard Pilgrim and Tufts Health Plan accounts and customers will remain the same as it is today.
Harvard Pilgrim and Tufts Health Plan will continue to use existing account reporting tools and broker compensation programs throughout 2021. You will be notified of any changes well in advance.
There will be no changes or impact to the administration of your plans through the end of 2021.
Checks should be sent to the same name and address that is currently being used. We will notify you well in advance if there are any changes.
Please send enrollment information to the same address currently used by — and by the same deadlines currently in place for — both Tufts Health Plan and Harvard Pilgrim.
Rates and Underwriting
- For 2021, small group underwriting will remain unchanged for both Harvard Pilgrim and Tufts Health Plan and we are committed to offering our current portfolio of products through the year.
- For large group business in 2021, we are working to unify pricing methodologies into a single rating process to the extent possible. We are working to deliver the best products and rates to your clients. Our underwriting teams are working collaboratively and are committed to delivering pricing that is aligned. We’ll coordinate and rate the risk in the same way. There may be product differentials that may cause some differences, but the pricing will be aligned. Our goal is to minimize disruption to our customers.
Yes, you can choose any quote from Tufts Health Plan or Harvard Pilgrim. Keep in mind that quotes are not interchangeable between Tufts Health Plan and Harvard Pilgrim. The quotes you receive from Tufts Health Plan are only applicable to their specific products and services. The quotes you receive from Harvard Pilgrim are only applicable to their products and services.
You will continue to contact your current Harvard Pilgrim or Tufts Health Plan sales or account representative. If or when there are any changes, you will be notified well in advance.
Products and Offerings
No. Whatever type of plan you or your clients need, we can deliver. For large group, this includes fully insured, self-insured (ASO) and third-party administrator (TPA) through Health Plans, Inc. For small groups, both Tufts Health Plan and Harvard Pilgrim product portfolios are available. In any type of business, we have a solution for you in all five states where we do business. We are very interested in bringing on new business, and we’re extremely well positioned to meet the needs of your clients with outstanding products and superior service.
Both Harvard Pilgrim and Tufts Health Plan products will be available for renewal through 2022. We are reviewing products and services offered by both heritage brands for renewals and new business as we move forward, and we’ll continue to communicate this information as it becomes available.
No, only Harvard Pilgrim commercial products and plans will be offered to the New Hampshire market from this point forward by the combined organization. In connection with the combination, Tufts Health Freedom Plan was acquired by UnitedHealthcare. Please see separate communications on this topic and visit the Tufts Health Freedom Plan website for further information.
Tufts Health Plan and Hartford Healthcare are partners in a joint venture that offers Medicare Advantage plans (branded as CarePartners of Connecticut) to eligible adults in Connecticut. The Medicare product offerings in Connecticut will not change as a result of this combination.
Tufts Health Direct is an option for individuals and smaller groups who are looking for an affordable, focused-network alternative. It is available in Massachusetts only.
We currently offer individual medical plans in Maine, New Hampshire and Massachusetts. We are constantly evaluating our product offerings and the individual plans in our other markets.
In the near term, there will be no changes to the Tufts Health Plan or Harvard Pilgrim provider networks. We are reviewing the provider networks with the intention of building the strongest networks for our members. We will notify you well in advance of any network changes.
Provider contracts are multi-year agreements, so aligning the networks will take multiple years. One of our major priorities is to leverage our contracts to be able to offer an expanded network for you and your clients, with seamless coverage from Connecticut to the tip of Maine. Our goal is to have this in place for 2023.
We are currently assessing our national network partners with the goal of making a decision about our national network for January 1, 2023. Both organizations will continue to leverage their national networks in the meantime, and all products will maintain their current and national networks through 2022.
We are currently evaluating our PBMs. All products will maintain their current PBM through at least 2022.
Both Harvard Pilgrim and Tufts Health Plan will be leveraging their existing care management models for 2021. We are evaluating the most effective care management approach for the future.
Both Harvard Pilgrim and Tufts Health Plan will be leveraging their existing behavioral health models and vendors through 2022. We are evaluating the most effective behavioral health model for the future.
We recognize the critical importance of behavioral health to the well-being of our members and how quality behavioral health care contributes to overall health of our members. We are committed to focusing on innovation and using data to continually improve access and quality of care, and we are prioritizing the integration of medical and behavioral health care management. We are looking forward to discussing this in more detail in the coming months as we advance our planning for behavioral health.
There will be no changes for 2021. We are currently evaluating both Harvard Pilgrim’s and Tufts Health Plan’s ancillary partners.
Both Harvard Pilgrim and Tufts Health Plan will leverage their existing wellness programs for 2021, and we are working on a solution for our well-being offerings for 2022 and beyond. Wellness is an area in which both Harvard Pilgrim and Tufts Health Plan have very strong programs, and we look forward to bolstering them further with an integrated solution.
The platform for commercial products will be Harvard Pilgrim’s OHI claims platform, and the migration will be carefully sequenced to ensure a seamless transition for all business. We are committed to operating parallel platforms for the immediate future, and our migration timeline will be staggered over the next few years. The one exception is Tufts Health Direct, which will remain on the heritage Tufts Health Plan platform.
For small group business, we plan to migrate all new and existing business to the OHI platform in January 2023, and we expect to have a single portfolio of small group product offerings beginning on that date.
We have a longer transition period in mind for large group business. Beginning on January 1, 2022, we plan to implement all new large group business on the OHI platform. This way, we won’t need to transition these groups later. If a client has a specific reason for wanting to utilize the Tufts Health Plan platform, then we will work to meet that client’s request. Our intent is that all small group business and all new large group business will be running on the OHI platform in 2023.
We plan to begin moving the existing Tufts Health Plan large group business to the OHI platform starting on January 1, 2024. We want to work with our broker partners to retain all business currently on the Tufts Health Plan platform, and there is no plan to move business for a couple of years.
We are very focused on ensuring that we are meeting the needs of all our customers and broker partners as we integrate our business and platform. We will be operating both platforms over the next few years, and clients will continue to experience the same strong service, support and rating process. We are committed to working with you to resolve any concerns and will be as flexible as possible to ensure success for our clients.
Moving to the OHI platform doesn’t mean that only Harvard Pilgrim products will be offered. We are looking closely at all the Tufts Health Plan and Harvard Pilgrim offerings and looking at introducing new, innovative products that deliver broad access, strong value and a superior customer experience.
Our goal is to meet the needs of our clients, and we want to work with you to retain all of our business and collaborate to arrive at the right solution. If there are unique program requirements that can’t be implemented on the OHI platform (and we can’t think of any at this time) we’ll be happy to work with brokers and the team to come up with a solution. The goal is to keep this process as seamless as possible to the clients, so we’ll run both systems in parallel for quite some time to make sure this happens.
No. Maintaining excellent customer service and experience is our top priority. Members will continue to access information and services through their existing member portals and contact each health plan using the same member services phone numbers they use today. Member ID cards will not change, and members will continue to access health care services, provider networks and benefits without interruption.
Both the Harvard Pilgrim and Tufts Health Plan broker compensation programs will remain in place throughout 2021. The combined organization will release its 2022 broker compensation program to the marketplace prior to Q4 2021.
Information about Medicare Business
Brokers will absolutely continue to be a big part of the distribution strategy for our combined organization. At this time, we do not anticipate any changes to how our products are sold.
There will be no changes at this time related to your current book of business.
At this time, there will be no changes to your current book of business. For any future changes, we will be proactively updating you as more information becomes available.
At this time, there will be no changes to your current book of business. We will continue to evaluate our product and plan strategy going forward. For any future changes, we will be proactively updating you as more information becomes available.
In the near term, nothing will change in regard to what you are able to sell. As we move forward, we will provide any pertinent updates.
Your current contracts will remain in place in the immediate future. We will provide updates if and when any future decisions are made.
There will be absolutely no changes to your current relationship with Harvard Pilgrim.
As a combined organization, Harvard Pilgrim and Tufts Health Plan will be better able to keep high-quality health care accessible and affordable, while at the same time investing in programs and initiatives that enhance quality of care and the experience of our customers. We will remain a mission-driven nonprofit organization, continuing its commitment to serving people of all socioeconomic backgrounds.
While we officially are one organization, both of our heritage brands and their products will remain in the market. The benefits, programs and services our members currently rely on will not change.
Growing and strengthening our Medicare business is a top priority for the new organization. We are actively working together to identify opportunities that will enhance and improve our capabilities and prospects for future growth.
For more information, please contact:
- Joseph_Zaza@tufts-health.com at Tufts Health Plan
- Lenieve Henry at Harvard Pilgrim: (617) 509-2595