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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

September 2015

Expanding our Medicare Advantage Service Area for 2016

With the Medicare Advantage open enrollment approaching (October 15–December 7), Harvard Pilgrim is pleased to announce that we’re expanding the service area for our Medicare Advantage Stride SM (HMO) products from 9 to 17 counties in Massachusetts, Maine, and New Hampshire:

  • Massachusetts: Bristol, Essex, Norfolk, Plymouth, Middlesex (excluding 01824, 01826, 01863), Suffolk, and Worcester
  • Maine: Androscoggin, Cumberland, Kennebec, Sagadahoc, and York
  • New Hampshire: Cheshire, Hillsborough, Merrimack, Rockingham, and Strafford

If you are a contracted Harvard Pilgrim provider who currently does not participate in our Medicare Advantage Stride network, but would like to offer care to our growing Stride membership, please contact your Harvard Pilgrim contract manager or call 888-609-0692.
Product overview

Harvard Pilgrim offers competitive product choices in the marketplace. For 2016, we will continue to offer the Stride Value Rx (HMO) and Stride Value Rx Plus (HMO). The Value Rx plans are our lowest monthly premium plans, while the Value Rx Plus plans offer enhanced benefits, including lower out-of-pocket copayments for doctors visits and inpatient stays, coverage for Tier 1 and Tier 2 medications in the Part D “coverage gap,” and an over-the-counter medication benefit.

As in 2015, Harvard Pilgrim offers a closed formulary for all Stride (HMO) products and Part D benefit designs, which includes coverage for some medications not typically covered by Medicare, such as erectile dysfunction drugs, select vitamins, and cough and cold medications (limits apply). For a more detailed description of the Stride (HMO) products, please see the Medicare Advantage Stride Medicare Advantage Stride product page in Harvard Pilgrim’s online Provider Manual.

Panel status reminder

If you currently participate in our Medicare Advantage Stride network, the Centers for Medicare and Medicaid Services (CMS) has asked health plans to work with participating providers to ensure that demographic data and panel status are kept up to date. As a reminder, please help us maintain an accurate Provider Directory by reviewing and updating your panel status. If your panel status or any other information is out of date, complete and submit a Provider Change Form.

For any questions about our Medicare Advantage Stride (HMO) plans or network participation, call the Medicare Advantage Provider Service Center at 888-609-0692.

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Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

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