Helpful tips to pick a plan
Harvard Pilgrim offers several types of health plans
Below is some helpful information to guide you in understanding the differences between our plans and choosing the one that’s best for you.
Get confident in your individual and family coverage. Harvard Pilgrim offers a variety of plans to fit the needs of you and your family. Discover what’s right by visiting our full list of individual plan options.
You receive care within Harvard Pilgrim’s network, select a primary care provider (PCP) and get referrals for most of your care.
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.
Tiered network plans (such as ChoiceNet and Maine’s Choices PlusSM3) can be HMOs or PPOs. Providers fall into tiers that determine the price you pay. You can choose which tier to receive services in.
Deductible/CDHP plans (such as Best Buy), can be HMOs or PPOs. You meet a deductible before services are paid by Harvard Pilgrim. Sometimes the plan will have a funding arrangement like an HRA (health reimbursement arrangement) or an HSA (health savings account) to help you meet your deductible.
| Preference | HMO | PPO | Limited Network | Tiered Network | Deductible/CHDP |
|---|---|---|---|---|---|
| My doctor participates in the network for my plan, and I don’t want to spend more money out-of-pocket. | X | X | X | X4 | |
| I want the freedom to see any doctor. | X | X4 | |||
| 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 | X5 | X5 | |
| 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-quality6 plan. | X | X | X | X | X |
Footnote(s)
1
Not all plans are available to all employers and/or individual members.
2
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 888-333-4742 to request a paper copy of the provider directory at no charge.
3
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 888-333-4742 to request a paper copy of the provider directory at no charge.
4
Applies to Best Buy HMO plans only.
5
This plan may include a deductible.
6
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.