Better understand your plan and how to get the most out of it.
Learn more about the latest state regulations and how upcoming changes may affect your coverage.
Massachusetts
Fully insured commercial Massachusetts plans
Fertility preservation services
In accordance with Massachusetts law, effective 7/1/2024, all fully insured commercial plans provide coverage for standard fertility preservation services, including, but not limited to, coverage for procurement, cryopreservation and storage of gametes, embryos or other reproductive tissue, for members with a diagnosed medical or genetic condition that may directly or indirectly cause impairment of fertility by affecting reproductive organs or processes.
Coverage for maternal health services
In accordance with Massachusetts law, effective 11/21/2024, all fully insured commercial plans will provide coverage for:
- Postpartum depression and major depressive disorder screenings
- Donor breast milk and donor human milk-derived products when determined medically necessary and ordered by a licensed medical practitioner for a covered infant under 6 months undergoing treatment in an inpatient setting for a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis or a congenital or acquired condition
- Universal postpartum home visiting services
New Hampshire
Fully insured commercial New Hampshire plans
Prosthetics for children under age 19 years old
In accordance with NH law, effective 1/1/25, coverage will be provided for one additional activity-specific prosthetic device for members under 19 years of age, including all materials for use, and repair or replacement when medically necessary.
This mandate applies to all fully insured commercial small group and large group plans. It does not apply to fully insured commercial individual plans.
Coverage for diagnostic and supplemental breast examinations
In accordance with NH law, effective 1/1/25, no cost sharing (including deductible, copayment, or coinsurance) will be applied to diagnostic mammograms, diagnostic breast examinations, supplemental breast examinations, breast ultrasounds or breast MRIs performed by an in-network provider.
For plans that meet the definition of a high deductible health plan, this requirement applies only after the member has met their deductible.
This mandate applies to all fully insured commercial individual, small group and large group plans.
Rhode Island
Fully insured commercial Rhode Island plans
Epinephrine auto-injectors and cartridges
In accordance with Rhode Island law, effective 1/1/25, a two (2) pack of epinephrine auto-injectors or cartridges are covered once every 12 months with no member cost sharing. Additional epinephrine auto-injectors or cartridges will be subject to applicable member cost sharing.
High dollar specialty drugs
In accordance with Rhode Island law, effective 1/1/25, copayment and coinsurance for certain high dollar specialty drugs will not exceed $150 for up to a 30-day supply. If your pharmacy plan includes a deductible, the deducible will still apply.
Prevention of HIV infection
In accordance with Rhode Island law, effective 1/1/25, the existing mandate for the Prevention of HIV Injection has been amended. Coverage is required for at least one pre-exposure (PrEP) drug in each method of administration and at least one of preferred post-exposure (PEP) drug treatment regimen without prior authorization, step therapy requirements or member cost sharing. For plans that meet the definition of a high deductible health plan, this requirement applies only after the member has met their deductible for preferred post-exposure (PEP) drugs.
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At Harvard Pilgrim, our goal is to provide you with detailed plan information to help guide you toward making the very best health care decisions for you and your family. Log in to your account and click on Plan Details and then View My Plan Documents to view, download, save and print benefits and coverage documents — including your benefit handbook.