Harvard Pilgrim has partnered with MaineHealth and its affiliates, as well as York Hospital, InterMed, and Martin’s Point to expand our product offerings in Maine with a new tiered-network HMO plan called Maine’s Choice. The product will be available to small employers and to individuals on and off the Maine Health Insurance Exchange/Marketplace (healthcare.gov) in ten counties: Androscoggin, Cumberland, Franklin, Kennebec, Knox, Lincoln, Oxford, Sagadahoc, Waldo, and York. Sales for Maine’s Choice begin on November 1, 2015, which is when open enrollment for the Maine Health Insurance Exchange/Marketplace begins.
Tiering and cost sharing
The Maine’s Choice HMO plan features two provider tiers: Preferred and Standard, each with separate member cost sharing. When members access providers in the Preferred tier, lower deductibles, coinsurance, copayments, and a lower out-of-pocket maximum amount apply. Maine’s Choice members must select their primary care physician (PCP) from the Preferred tier.
For more information on participating providers and their tier, please refer to the provider directory online or in HPHConnect after October 1, 2015.
You can recognize Maine’s Choice members by their ID card, which will indicate “Maine’s ChoiceSM HMO” in the upper right corner, as in the sample below.
For more information, please refer to the Maine’s Choice HMO product page in our online Provider Manual.