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|Plan Name||Year||Overview||Documents||Administration Forms|
|Focus CTSM HSA HMO||2021||High-deductible (QHDHP) HMO plan. Select providers across CT, plus the rest of our New England network. PCP selection and referrals required. Members must use Focus CT HMO providers, except in medical emergencies. Gives employers and/or members the option to fund a health savings account.||Focus CTSM HMO Employer Flyer|
|Focus CTSM HMO||2021||Select providers across CT, plus the rest of our New England network. PCP selection and referrals required. Members must use Focus CT HMO providers, except in medical emergencies.||Focus CTSM HMO Employer Flyer|
|HMO||20192020||No referral, no PCP, open-access HMO, available with or without deductible and offers access to our full network of New England providers and hospitals.||Perks of Harvard Pilgrim membership||Pre-Renewal|
|HMO HSA||20192020||High-deductible (QHDHP) PPO plan. Provides access to local and national providers and hospitals without referrals. Out-of-network access to non-participating providers. Gives employers and/or members the option to fund a health savings account. No PCP or referral is required.||Perks of Harvard Pilgrim membership||Pre-Renewal|
Benefits, coverage and member cost-sharing details for our plans.
Schedules of Benefits and SBCs: Connecticut
Small Group 2019
|HMO 25/35 Copay MD0000004903||Show HMO 25/35 Copay SOB||Show HMO 25/35 Copay SBC|
|HMO 2250 Hospital MD0000004904||Show HMO 2250 Hospital SOB||Show HMO 2250 Hospital SBC|
|HMO 2500 Hospital MD0000004905||Show HMO 2500 Hospital SOB||Show HMO 2500 Hospital SBC|
|HMO 2000 with Coinsurance MD0000004906||Show HMO 2000 with Coinsurance SOB||Show HMO 2000 with Coinsurance SBC|
|HMO 3000 Hospital MD0000004919||Show HMO 3000 Hospital SOB||Show HMO 3000 Hospital SBC|
|HMO 5000 with Coinsurance MD0000004907||Show HMO 5000 with Coinsurance SOB||Show HMO 5000 with Coinsurance SBC|
|HMO HSA 3000 MD0000004908||Show HMO HSA 3000 SOB||Show HMO HSA 3000 SBC|
|HMO HSA 4000 with Coinsurance MD0000004909||Show HMO HSA 4000 with Coinsurance SOB||Show HMO HSA 4000 with Coinsurance SBC|
|HMO HSA 2800 MD0000004918||Show HMO HSA 2800 SOB||Show HMO HSA 2800 SBC|
Small Group 2020
|OAH - OFF EXCHANGE with Dental||SOB||SBC|
|HMO 15/40 Copay MD0000005197||Show HMO 15/40 Copay SOB||Show HMO 15/40 Copay SBC|
|HMO 2500 Hospital MD0000005200||Show HMO 2500 Hospital SOB||Show HMO 2500 Hospital SBC|
|HMO 4000 Hospital MD0000005202||Show HMO 4000 Hospital SOB||Show HMO 4000 Hospital SBC|
|HMO HSA 2800 MD0000005205||Show HMO HSA 2800 SOB||Show HMO HSA 2800 SBC|
|HMO HSA 3000 Copay MD0000005207||Show HMO HSA 3000 Copay SOB||Show HMO HSA 3000 Copay SBC|
|HMO HSA 4500 MD0000005209||Show HMO HSA 4500 SOB||Show HMO HSA 4500 SBC|
|HMO 2000 with Coinsurance MD0000005212||Show HMO 2000 with Coinsurance SOB||Show HMO 2000 with Coinsurance SBC|
|HMO 3500 with Coinsurance MD0000005214||Show HMO 3500 with Coinsurance SOB||Show HMO 3500 with Coinsurance SBC|
|HMO 5200 with Coinsurance MD0000005216||Show HMO 5200 with Coinsurance SOB||Show HMO 5200 with Coinsurance SBC|
Offerings that enhance our value for members, employers and brokers. Fees may apply to some programs.
Medical and Pharmacy
Transparency tools, pharmacy information and other resources for when members need guidance with their care.
Programs for helping members keep more of their money.
Estimate My Cost
This search tool lets members find and compare estimated health care costs before they receive services. It’s available to members in CT, MA, ME and NH.
Additional Products & Programs
Student Insurance for Colleges and Universities
Underwritten by HPHC Insurance Company (“HPHC”) and administered by UnitedHealthcare StudentResources.
Harvard Pilgrim and Guardian are partnering to provide a full line of ancillary insurance products to employers in Connecticut, Maine, Massachusetts and New Hampshire. Learn how your clients can save money and provide more insurance options for their employees.
HSAs and HRAs
HSAs and HRAs can offset the costs of high-deductible health plans and motivate members to make smarter health care decisions. Our preferred vendors can get you and your clients started.
Whether emotional, physical, or financial, every aspect of life influences well-being, both at work and at home. Our holistic program takes this into account with personalized activities and resources that nourish each dimension of well-being in a meaningful, impactful way.
Behavioral health and substance use issues can be complex, confusing and overwhelming. We provide members with access to resources that will get them on the right path.
As industry leaders in population health, we combine data and analytics with robust care-management outreach. Our “whole person” approach to care encourages wellness and contains costs.