Save on premium with tiered network plans that are easy for members to understand and use. Members spend less out-of-pocket when using hospitals and affiliated facilities that practice more cost-efficiently.
- Members pay less out-of-pocket when going to
Tier 1 hospitals
- Members pay more out-of-pocket when going to
Tier 2 and Tier 3 hospitals
- More than 75% of hospitals are in Tier 1 and Tier 2
- All three tiers include hospitals from our
Quality Honor Rolls
- Emergency room care is always Tier 1 (regardless of hospital tier)
- Members save money on outpatient services such as labs and
X-rays when they’re done at independent or freestanding facilities, or Tier 1 hospitals
Hospital Prefer complements Harvard Pilgrim’s Best Buy portfolio of tiered copayment HMOs and PPOs with deductibles.
Two plan designs available
1. Single deductible option (also known as Hospital Prefer 2000), available to all employers
- Features one deductible for all hospital tiers and applicable outpatient services.
- Once deductible is reached, copayments vary in dollar amount based on hospital’s tier for these select hospital-based services: inpatient hospital stays, outpatient procedures or day surgery and high-end radiology.
- Services performed at Tier 1 hospitals and freestanding facilities typically are covered in full once deductible is reached. Tiers 2 and 3 have incrementally higher copayment amounts.
- These plans cover labs in full once the deductible is met.
2. Plan designs with general and hospital deductible, available to mid-to-large employers
- General deductible: Dollar amount that applies to services received at non-tiered facilities, including freestanding imaging center and lab providers.
- Hospital deductibles: Three different dollar amounts that apply to services received at hospitals and their affiliated centers or offices. Three hospital deductible levels are incrementally higher based on hospital tier.
General and hospital deductibles accumulate. If members receive services that apply to one deductible, that dollar amount applies toward the other deductibles. The Tier 3 hospital deductible is the most members pay for an annual deductible.
About participating hospitals
The Hospital Prefer network includes all Massachusetts acute care hospitals except for five who elected not to participate in the Hospital Prefer network. These non-participating hospitals, located in Western Massachusetts and Cape Cod, are: Baystate Franklin Medical Center, Baystate Mary Lane Hospital, Baystate Medical Center, Cape Cod Hospital and Falmouth Hospital.
Some of their affiliated provider groups have also elected not to participate in Hospital Prefer. To find providers participating in Hospital Prefer, use our online search tool.
Visit the Hospital Prefer member page.
This plan includes a tiered network called Hospital Prefer. In this plan, members pay different levels of cost sharing depending on the tier of the hospital delivering a covered service or medical supply. A hospital's benefit tier may change annually on January 1. Please consult the Harvard Pilgrim Hospital Prefer Provider Search Tool to determine a hospital's tier in the Hospital Prefer Network. You may also call Harvard Pilgrim at 1-888-333-4742 to request a paper copy of the provider directory.