Explore your 2026-2027 health plan options

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We're here to help you choose

Whether you are considering Harvard Pilgrim Health Care for the first time or you are interested in exploring a different plan for 2027, the dedicated team at our pre-enrollment SmartStart call center will help answer your questions about the plans we offer for GIC members. They can help you understand the benefits, programs and services available to you as a Harvard Pilgrim member. 

Learn more about SmartStart

Quality HMO

Plan details

  • This plan has a smaller network with fewer participating health care providers and hospitals, but with a lower premium than the Explorer POS plan
  • You are required to choose a PCP and receive covered services directly from your PCP or from other Harvard Pilgrim participating providers with the appropriate referrals 
  • In-network coverage only — there are no out-of-network benefits, unless you have a medical emergency, or you need urgent care outside of the Quality HMO service area 
  • You pay lower copayments for office visits to specialists and for inpatient hospital care when you use Tier 1 providers in the Quality HMO network. The network is limited to Tier 1 and 2, with no Tier 3 providers 
  • You must live in Massachusetts (excluding Cape Cod and Islands) to take advantage of this plan

Hospitals

Although certain primary care providers and specialists may participate in the Quality HMO network, the hospitals where they send their patients may not. If your provider refers you to a hospital that is not in the Quality HMO network, coverage will not be provided under your Quality HMO plan.

Tiering

It is very important to check the tier assignments for each provider for you and your covered dependents. 

Providers’ tier assignments may change during the year if they change practice affiliations. A provider may practice at more than one location and may have a different tier at each practice, based on their affiliation there. Different out-of-pocket costs may apply to the same provider based upon where you are treated by that provider.

 

Plan documents

Watch the Virtual Benefit Fair presentation

Explorer POS

Plan details

  • Features a full network — any provider contracted with Harvard Pilgrim is part of the Explorer POS plan 
  • The network is tiered for affordability
  • Offers the highest level of coverage with in-network services with a PCP, specialist coverage with a PCP referral or via our national network 
  • The plan also covers out-of-network services, with deductible and coinsurance 
  • You must live in CT, MA, ME, NH, RI or VT to take advantage of this plan

Tiering 

It is very important to check the tier assignments for each provider for you and your covered dependents. 

Providers’ tier assignments may change during the year if they change practice affiliations. A provider may practice at more than one location and may have a different tier at each practice, based on their affiliation there. Different out-of-pocket costs may apply to the same provider based upon where you are treated by that provider.

 

Plan documents

Watch the Virtual Benefit Fair presentation

Access America 

Plan details

Access America is a Harvard Pilgrim-UnitedHealthcare (UHC) joint venture product offering a unified option to our groups for employees nationwide. 

  • You can visit Harvard Pilgrim’s participating doctors, health professionals and hospitals in Massachusetts, Maine and New Hampshire, and UnitedHealthcare’s participating doctors, health professionals and hospitals in all other states
  • The plan also covers out-of-network services, with deductible and coinsurance
  • You must live in U.S. and outside of the six New England states (Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island and Vermont)
  • A PCP is not required but recommended and referrals are not necessary
  • You pay a flat copayment for services with a PCP or specialist

Plan documents

Watch the Virtual Benefit Fair presentation

Medicare Enhance

Plan details

  • Office visits are typically covered with just a simple copayment 
  • You can live anywhere in the United States, and must be enrolled in Medicare Parts A and B
  • You can visit any doctor or other provider that accepts Medicare
  • You have coverage for emergency care anywhere in the world
  • You enjoy savings on products and programs to help live a healthier life

Plan documents

Watch the Virtual Benefit Fair presentation