Beginning January 1, 2017, Harvard Pilgrim will offer ElevateHealth Options, a new tiered, defined-network HMO product. The product is designed to provide better patient experiences and improved outcomes at an affordable cost, while offering more options than original ElevateHealth. ElevateHealth Options members have the choice to seek care from inside of the ElevateHealth network, which is most cost effective, or to receive care from any contracted Harvard Pilgrim provider.
Tiering and cost sharing
ElevateHealth Options will feature two provider tiers. Tier 1 consists of all providers in the current ElevateHealth network in New Hampshire’s Hillsborough, Merrimack, and Cheshire counties, as well as portions of Grafton and Rockingham counties. When members seek treatment within this tier, lower deductibles, coinsurance, copayments, and a lower out-of-pocket maximum amount will apply. Tier 2 includes all other Harvard Pilgrim network providers in New Hampshire, Massachusetts, Vermont, Maine, and Connecticut; accessing care from a Tier 2 provider will result in a higher member cost share.
ElevateHealth Options members are required to select a primary care physician (PCP), but may choose one from either tier. For PCPs, the referral process for ElevateHealth Options members will be the same as with any full-network product. Since members may seek care from any Harvard Pilgrim network provider, there will be no need to make a distinction between “Easy Access” or “Authorized Access” status among providers in the ElevateHealth network.
You can recognize ElevateHealth Options members by their ID card, which will indicate “ElevateHealth Options” in the upper right corner, as in the sample below.
For more information, please refer to the ElevateHealth Options product page
in our online Provider Manual.