How this plan works
- You have access to the full Harvard Pilgrim network but this plan places in-network providers and hospitals into one of two tiers
- Custom network is a tiered into Tiers 1, 2, and Out-of-Network
- Tier 1: CCHC network
- Tier 2: HPHC network
- OON
- A Cape Cod Healthcare PCP (Tier 1) is required, a member has the option to choose a Tier 2 PCP, but you will have the lowest out-of-pocket cost when you see Cape Cod Healthcare PCP
- This plan requires referrals from your PCP to see a Specialist
- The plan also covers out-of-network services, with deductible and coinsurance
- Enrollees must live on Cape Cod
Union plans
Summary of Benefits & Coverage 13
Schedule of Benefits – SEIU and CCH UGSOA DPO
Summary of Benefits & Coverage 19
Schedule of Benefits – MNA DPO
Summary of Benefits & Coverage 22
Non-union plans
Summary of Benefits & Coverage 1
Summary of Benefits & Coverage 2
For more information about your new benefits, including estimating your out-of-pocket costs and more, contact our SmartStart team at SmartStart@harvardpilgrim.org or call them at 866-874-0817.