Ask Member Services
Get in touch when you need answers
When you have questions about your benefits and coverage with Harvard Pilgrim, we’re here for you. See if your question is answered here, or get in touch with Member Services directly.
Does my doctor participate with Harvard Pilgrim?
Find out by calling your doctor or search our online directory.
What are the benefits of having a secure online account and how do I set one up?
A secure online account helps you manage your health plan through a wide variety of resources. You can review claims and authorizations, track your deductible if you have one, use fitness and wellness tools, and more.
Members 18 years old and older must create their own individual accounts even if they are on their parent’s plan.
Do I need a Primary Care Provider (PCP)?
It depends on the type of plan you have. If you have an HMO or POS plan, you must choose a PCP. PPO members are not required to choose a PCP, but it’s typically recommended.
How do I change my PCP?
You can change your PCP by logging into your secure online account, or calling Member Services.
How do I learn about my plan?
Check your Schedule of Benefits in My Plan Documents in your secure online account. This document is specific to your plan and tells you what is covered and what you pay for services.
Am I covered if my doctor recommends I see a specialist?
HMO Members: You will need a referral from your PCP and you must see a participating specialist.
POS Members: You will need a referral for authorized coverage. If you don’t get a referral or choose to go out-of-network, you will have higher costs.
PPO Members: If you see a participating specialist, your costs will be lower than if you see a non-participating specialist.
What is considered preventive care?
Under the Affordable Care Act, also known as the ACA or the PPACA, there are designated services that are considered preventive and must be covered with no cost to members. You receive preventive services whether you are well or sick. They are benchmarks to assess your health and they determine if you need more specialized care.
It’s not an emergency but I need urgent care. Where can I go?
As a Harvard Pilgrim member, you are covered for urgent care at retail clinics, urgent care clinics, and other convenient options.
Am I eligible for a gym or fitness reimbursement?
Every plan is different. Log into your secure online account to find out if your plan offers a reimbursement.
Learn details about how the fitness reimbursement works.
Why did I receive a questionnaire asking me if I have another insurance plan in addition to Harvard Pilgrim?
If we receive a claim for a service that indicates a member received care after an accident, we send the member a questionnaire. The completed questionnaire helps us determine if another insurance should pay because a third party (a person or business) was responsible for the accident. We can then process claims correctly. The questionnaire should be submitted within 60 days of receipt.
Where can I get a covered flu shot?
Adults with Harvard Pilgrim plans can get a flu shot at no charge at:
- Your PCP/Specialist
- CVS MinuteClinics in MA, NH, ME, RI and CT (not covered in other states)
- Pharmacies that participate in MedImpact (members 19 years and older only)
- MA city/town public clinics coordinated through the MA Department of Public Health and billed to HPHC by Commonwealth Medicine
- Public clinics run and billed by New England Nurses (MA, Southern NH, and parts of RI)
- Public clinics run and billed by Harvard Pilgrim contracted Home Health Agencies
- Your employer. Check with your Human Resources department to see if your company is offering it
Children with Harvard Pilgrim plans can get a flu shot at no charge at:
- Your child’s pediatrician
- City/town flu clinics in schools or public clinics for children and adults
Always call ahead to confirm schedules and availability, and make sure the provider or clinic accepts Harvard Pilgrim insurance and will submit a claim. Always bring your ID card with you.
Am I covered for a screening colonoscopy?
A colonoscopy is an ACA preventive services . It’s covered at no cost to members when received from a provider who is part of your Harvard Pilgrim network.
Are breast pumps covered by my insurance plan?
As part of Federal Health Care Reform (FHCR) Women’s Preventative Coverage, the following breast pumps and related supplies are covered with no cost sharing.
- A4281 Tubing for breast pump, replacement
- A4282 Adapter for breast pump, replacement
- A4283 Cap for breast pump bottle, replacement
- A4284 Breast shield and splash protector for use with breast pump, replacement
- A4285 Polycarbonate bottle for use with breast pump, replacement
- A4286 Locking ring for breast pump, replacement
- E0602 Breast pump, manual, any type — this is a purchase only item
- E0603 Breast pump, electric (AC and/or DC), any type
- E0604 Breast pump, hospital grade, electric (AC and/or DC), any type. 3 month Rental
Your insurance plan also covers comprehensive lactation support, counseling, and the costs of renting breastfeeding equipment. The following items are not covered: Nursing pads, gel pads, nipple cream, and milk storage bags.
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Wednesday: 10 a.m. to 6 p.m.
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