Beginning on Sept. 1, 2021, Harvard Pilgrim will offer a uniquely convenient new product known as Virtual ChoiceSM HMO to employer groups in Maine, New Hampshire, and Connecticut. In addition, SimplyVirtualSM HMO — which was recently introduced for Maine and New Hampshire and features a virtual-first care model — will be offered in Massachusetts as of Jan. 1, 2022, pending regulatory approval.
How Virtual ChoiceSM HMO works
Virtual ChoiceSM HMO will provide adult members ages 19 and older with the choice between two primary care options: they may select a virtual PCP from Doctor On Demand’s network and access their PCP through real-time video visits using the Doctor On Demand app or website, or they may opt instead for office-based care and select a PCP from Harvard Pilgrim’s network.
Cost sharing for most services will be lower for members who select the virtual primary care option, and virtual PCPs will refer members for any necessary office-based care, such as labs, x-rays, immunizations, and specialist visits.
Members under age 19 will need to select an office-based PCP from Harvard Pilgrim’s network.
Identifying cost share
For Virtual ChoiceSM HMO, the 271 eligibility response transaction includes information to help you identify provider cost-sharing, including: an explanation of member cost share, member age, and whether the member has selected a Doctor on Demand provider (resulting in lower member cost shares) or is eligible to select a Doctor On Demand PCP but did not opt to do so (resulting in higher member cost shares).
You can also recognize Virtual ChoiceSM HMO and SimplyVirtualSM HMO members by their ID cards; for further information, refer to the Member Identification Cards policy in Harvard Pilgrim’s online Provider Manual.
Director, Network Operations