These are PPO deductible plans and unlike the HMO, members are not required to select a PCP or obtain referrals for specialty care. Members can choose to receive services within the Harvard Pilgrim contracted provider network or, for higher out-of-pocket costs, seek medically appropriate services from providers that are not contracted. This plan is required for anyone residing outside of New England.
Like HMO LP, the PPO plans include the unique feature of allowing members to save money when receiving diagnostic lab testing and outpatient surgery procedures from LP providers, as explained above. It’s important to note that if these services are received out of the network or from non-LP providers, members will not have access to these savings.
- Schedule of Benefits (SOB) (pdf)
- Summary of Benefits & Coverage (SBC) (pdf)
- Premium 4 Tier Prescription Drug Coverage (pdf)