Harvard Pilgrim Health Care and the Group Insurance Commission (GIC) are updating our product offerings for the 2017–2018 plan year. The following is a brief overview of Harvard Pilgrim’s GIC plans for the 2017–2018 plan year, which begins on July 1, 2017.
Primary Choice HMO—Primary Choice is a limited-network HMO, open to Massachusetts residents (except in Martha’s Vineyard, Nantucket, and Cape Cod) who are active GIC enrollees, retired GIC enrollees not eligible for Medicare, retired municipal teachers, and certain other government retirees. The Primary Choice Plan includes a deductible, lower PCP copayment, two copayment tiers for specialist office visits, and two copayment tiers for inpatient admissions to acute care hospitals.For more information about this product, please refer to the Primary Choice HMO product page
in our online Provider Manual.
Independence Plan POS—The Independence Plan is a POS, open to Massachusetts state and municipal employees, that allows members to seek in-network medical care (from their PCP or from Harvard Pilgrim participating providers with a PCP referral) or out-of-network medical services (from non-participating providers or Harvard Pilgrim participating providers without a PCP referral). The Harvard Pilgrim GIC Independence Plan offerings include a deductible, a lower PCP copayment, and three copayment tiers for specialist visits and inpatient admissions to acute care hospitals. For more information about this product, please refer to the Independence Plan POS product page in our online Provider Manual.
For the 2017-2018 plan year, we have made some changes to our approach with the physician tiering, with Harvard Pilgrim performing tiering at the physician group level for our GIC plans. Previously, tiering was performed at the individual provider level. This change creates greater consistency for patients receiving care from PCPs and specialists within the same provider group. Hospital admission copayments are based on hospital tier assignment. Tier assignments are the same for both plans; however, not all hospitals participate in Primary Choice HMO. Tier assignments for physician groups and hospitals are based on quality and cost-efficiency data.
For all general questions about the Independence or Primary Choice Plan, call the Provider Service Center at 800-708-4414.