Tips to Pick a Plan

Think about your preferences to find the plan that’s right for you

Harvard Pilgrim offers several types of plans. Here is some basic information to help you understand plan differences. What types of plans does Harvard Pilgrim offer?

HMO:
You receive care within Harvard Pilgrim’s network, select a PCP and get referrals for most of your care.

PPO
You are covered for in-network services and have the option to go out of network for a higher out-of-pocket cost. You don’t need referrals.

Limited Network plans, such as Focus NetworkSM and ElevateHealthSM*
Your costs are lower because your network of providers is smaller.

Tiered Network plans, such as ChoiceNet and Maine’s ChoiceSM**
Can be HMO or PPO. Providers fall into tiers which determine the price you pay. You can choose which tier to receive services. Brief presentation on how tiered network plans work.

Deductible/CDHP plans, such as Best Buy
Can be HMO or PPO. You meet a deductible before services are paid by Harvard Pilgrim. Sometimes the plan will have a funding arrangement like an HRA or an HSA to help you meet your deductible.

Note: Not all plans are available to all employers and/or individual members

See which plan might meet your needs:

X marks the spot.

HMO

PPO

Limited Network

Tiered Network

Deductible/CDHP

My doctor participates in the network for my plan and I don’t want to spend more money out-of-pocket.

X

 

X

X

X
(Best Buy HMO plans)

I want the freedom to see any doctor.

 

X

 

 

X
(Best Buy PPO plans)

I want to save on my premium (money paid up front for health coverage).

 

 

X

X

X

I want services to be covered up front and don’t mind a higher premium.

X

X

X*

 

*plan may include a deductible

X*

 

*plan may include a deductible

 

I prefer to budget and keep track of all my health care expenses.

 

 

 

X

X

I want a plan that lets me save money when I choose specified providers.

 

 

 

X

 

I want a high quality*** plan.

X

X

X

X

X

Now go choose your plan! 

 

*These plans provides access to a limited provider network that is smaller than Harvard Pilgrim’s full provider network. In these plans, members have coverage only from providers in the network specific to their plan. Please search the provider directory by plan name for a list of providers. You may also call Harvard Pilgrim to request a paper copy of the provider directory at no charge.

**Tiered Network plans include a tiered provider network. In these plans, members pay different levels of cost sharing depending on the tier of the provider delivering a covered service or medical supply. A provider’s benefit tier may change annually on January 1. To determine a provider’s tier in a specific plan’s network, please search the Harvard Pilgrim provider directory by plan name. You also may call Harvard Pilgrim to request a paper copy of the provider directory at no charge.

***Consistently among the nation’s highest-rated health plans, Harvard Pilgrim Health Care (private HMO/POS and PPO plans) and Harvard Pilgrim Health Care of New England (private HMO/POS plans) have been rated 4.5 out of 5 in NCQA’s Private Health Insurance Plan Ratings 2016-17. NCQA’s Private Health Insurance Plan Rankings, 2011-15, HMO/POS/PPO.