In the normal course of visiting the Harvard Pilgrim website, downloading information, or searching for our products or services, we (or a third party on our behalf) may gather and store certain information about your browsing activity automatically. We use this information to help us make the site more useful to visitors — to learn about the number of visitors to our site and the types of technology our visitors use. Unless specifically stated otherwise, no additional information will be collected about you.
We (or a third party on our behalf) may collect and store the following types of information about your browsing activity:
Some pages on this website employ browser session "cookies." A cookie is a small piece of data that a website transfers to your computer's hard drive to allow the server to distinguish your session from that of others while you are connected. Requests to send cookies are not designed to collect information about you, but only about your browser session. The cookies make it easier for you to use the dynamic features of our website. The cookies and the information about your session are automatically destroyed shortly after you close your browser. The information is not permanently stored on your computer. We do not collect personal information about you except as described previously.
Harvard Pilgrim is committed to ensuring the privacy and confidentiality of our members' protected health information (PHI). We collect and disclose such information only according to our strict confidentiality policies and federal and state laws designed to maintain privacy, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule. The HIPAA Privacy Rule took effect on April 14, 2003, and requires Harvard Pilgrim to provide its members with a Notice of Privacy Practices. The notice explains how we use information about our members and under what conditions we are permitted to share that information with others.
Unless otherwise permitted by HIPAA, we will not disclose to third parties that are not our vendors any identifying data, including name, mailing address, email address and phone number, unless you authorize such disclosure, or such disclosure is required by law. To ensure privacy of your data, never share your username and password with anyone. Be sure to consider the content of any questions, the location of your email account and who, besides yourself, may have access to it.
We collect personally identifiable data through our web services in the following ways:
Security is a priority at Harvard Pilgrim. Appropriate measures are taken to protect the confidentiality, integrity and availability of information about our members, providers, employers, brokers and anyone else who may want to use our website.
Only authorized users are allowed to access protected health information (PHI). Harvard Pilgrim enforces a high level of protection for securing transmissions between a user's browser and this website. Content on this site is protected against unauthorized access.
Please be aware that communications sent using unencrypted email are not inherently secure. It is possible that they can be intercepted while in transit and read. Harvard Pilgrim cannot guarantee the confidentiality or security of any information you send to us over the internet when it is sent using unencrypted email. Harvard Pilgrim will not be responsible for any breach of confidentiality resulting from your use of unencrypted email transmission.
Harvard Pilgrim maintains a corporate email policy governing the use of email when communicating confidential and/or health information, which includes implementing reasonable and appropriate safeguards when communicating via email.
We periodically email well-being and benefit-related information to our members to help them make the most of their plan. Each time we send an email, the recipient is given the opportunity to opt out of receiving similar emails in the future.
Medical questions or concerns about your care or treatment should be directed to appropriate health care professionals. Harvard Pilgrim will not respond to requests for personal medical advice made through this website. If you require an immediate response to non-medical questions or problems, please call Member Services at (888) 888-4742 (TTY: 711).
Email forms on our site should not be used for confidential personal medical issues but for general topics or product questions. If you wish to discuss personal information related to Harvard Pilgrim services, you should call Member Services, and not use email. We will share your comments and questions with our member services coordinators and those employees most capable of addressing your questions and concerns, as covered under personal health information, above. Your email may not be encrypted and may be accessed and viewed by other internet users without your knowledge while in transit to us. See email security.
© 2024 Harvard Pilgrim Health Care, Inc. All rights reserved.
The information posted on this website is protected by copyright and other intellectual property rights. It may be displayed, reformatted and printed for personal, non-commercial use only. Any copy of information obtained through the website must include the copyright notice. Removing or altering the copyright notice on any material on this website is prohibited. Use or misuse of Harvard Pilgrim's trademarks, service marks or logos is expressly prohibited and may violate state and federal law.
This notice describes how medical information about you may be used and disclosed and how you can get access to this information.1 Please review it carefully.
Download the Notice of Privacy Practices (pdf)
Download the Notice of Privacy Practices for Medicare Advantage (pdf)
Harvard Pilgrim values your privacy rights and is committed to safeguarding your demographic, medical, and financial information we may receive or collect when providing services to you. The information we collect includes protected health information (“PHI”) and personal information (“PI”). PHI is information that relates to your physical or behavioral health condition, your health care, or the payment for your health care. PI includes information like your name and Social Security number. PHI and PI are referred to as “information” elsewhere in this notice. Harvard Pilgrim Health Care protects oral, written, and electronic information throughout our organization.
We may obtain your information from a number of sources, such as through your enrollment in a plan or from doctors and hospitals who submit claim forms containing your information so that we may pay them for services they provided to you. We are required by law to maintain the privacy of your information. To support this, Harvard Pilgrim has privacy and security policies for safeguarding, using, and disclosing information in compliance with applicable state and federal laws. All employees must complete annual privacy and security training, and access to your information is limited to employees who require it to do their job. Harvard Pilgrim also requires its business partners who assist with administering health care coverage to you on our behalf to protect your information in accordance with applicable laws.
Harvard Pilgrim is required to provide you with notice of our legal duties and privacy practices with respect to your information, and to follow the duties and practices described in the notice currently in effect. We may change the terms of this notice at any time and apply the new notice to any information we already maintain. If we make an important change to our notice, we will publish the updated notice on our website at www.harvardpilgrim.org. We will also notify you of the change by mail or electronically, as permitted by applicable law. For members enrolled in a student health plan offered by HPHC Insurance Company and administered by UnitedHealthcare Student Resources, you may also access the revised notice at www.uhcsr.com.
In order to administer your health care coverage, including paying for your health care services, we need to use and disclose your information in a number of ways. Harvard Pilgrim maintains and enforces company policies governing the use and disclosure of information, including only using or disclosing the minimum amount of information necessary for the intended purpose. The following are examples of the types of uses and disclosures we are permitted or required by federal law to make without your written authorization. Where state or other federal laws offer you greater privacy protections, we will follow the more stringent requirements.
Harvard Pilgrim may use or disclose your information for payment purposes to administer your health benefits, which may involve obtaining premiums, determination of eligibility, claims payment, and coordination of benefits. Examples include:
Harvard Pilgrim may use or disclose your information for operational purposes, such as care management, customer service, coordination of care, or quality improvement. Examples include:
Harvard Pilgrim may use and disclose your information for health care providers (doctors, dentists, pharmacies, hospitals, and other caregivers) to treat you. Examples include:
The following are examples of the additional types of uses and disclosures Harvard Pilgrim is permitted or required by law to make without your written authorization:
Other than the permitted or required uses and disclosures described above, Harvard Pilgrim will only use and disclose your information with your written authorization.
For example, we require your authorization if we intend to sell your information, use or disclose your information for marketing or fundraising purposes, or, in most cases, use or disclose your psychotherapy notes.
You may give us written authorization to use or disclose your information to any individual or organization for any purpose by submitting a completed authorization form. The form can be found at www.harvardpilgrim.org, or you may obtain a copy by calling Member Services at the phone number listed on your Harvard Pilgrim ID card. For members enrolled in a student health plan offered by HPHC Insurance Company and administered by UnitedHealthcare Student Resources, the form can be found at www.uhcsr.com.
You may revoke such an authorization at any time in writing, except to the extent we have already made a use or disclosure based on a previously executed authorization.
The following are examples of your rights under federal law with respect to your information. You may also be entitled to additional rights under state law.
You have the right to request we restrict the way we use and disclose your information for treatment, payment, or health care operations, to individuals involved in your care, or for notification purposes, including asking that we not share your information for health research purposes. We are not, however, required by law to agree to your request.
You have the right to request we send communications to you at an address of your choice or that we communicate with you by alternative means. For example, you may ask us to mail your information to an address that is different than your subscriber’s address. We will accommodate reasonable requests.
You have the right to access, inspect, and obtain a copy of your information maintained by Harvard Pilgrim (with certain exceptions). We have the right to charge a reasonable fee for the cost of producing and mailing copies of your information.
You have the right to request we amend your information if you believe it is incorrect or incomplete. We may deny your request in certain circumstances, such as when we did not create the information. For example, if a provider submits medical information to Harvard Pilgrim that you believe is incorrect, the provider will need to amend that information.
You have the right to request an accounting of those instances in which we disclosed your information, except for disclosures made for treatment, payment, or health care operations, or for other permitted or required purposes. Your request must be limited to disclosures in the six years prior to the request. If you request an accounting more than once in a 12-month period, we may charge you a reasonable fee.
You have the right to receive a paper copy of this notice from us at any time upon request.
You have the right to be notified if there is a breach of your unsecured information by us or our business partners. We will provide you written notice via mail, unless we do not have up-to-date contact information for you. In these cases we will notify you by a substitute method, such as posting the notice on our public website.
You may exercise any of your privacy rights described above by contacting Member Services at the phone number listed on your Harvard Pilgrim ID card. In some cases, we may require you to submit a written request. Harvard Pilgrim will not require you to waive your rights as a condition of the provision of treatment, payment, enrollment in a health plan, or eligibility for benefits.
If you believe your privacy rights have been violated or you would like more information, you may send a question or complaint to:
Privacy Officer
Point32Health
1 Wellness Way
Canton, MA 02021
Or, you may call our Compliance Hotline at (877) 824-7123 or Member Services at the phone number listed on your Harvard Pilgrim ID card.
You also have the right to submit a complaint to the Secretary of the Department of Health and Human Services. You can find more information at www.hhs.gov/ocr.
Harvard Pilgrim will not take retaliatory action against you for filing a complaint.
THIS NOTICE IS EFFECTIVE SEPTEMBER 1, 2022, AND REPLACES THE VERSION DATED MARCH 15, 2022.
You can help us to detect and prevent health care fraud and abuse. It is important that you review activity statements, explanations of benefits and claim summaries to ensure that you actually received the services that are billed to Harvard Pilgrim. Here are some examples of potential fraud and abuse:
For more information about fraud and abuse, review Harvard Pilgrim’s Fraud, waste and abuse policy (pdf) .
To report potential health care fraud and abuse, or if you have questions, please call our confidential hotline number at 877-824-7123. You are not required to provide your name or member information; anonymous reporting is accepted. You can also send an anonymous letter to us at:
Harvard Pilgrim Health Care
Special Investigations Unit
1 Wellness Way
Canton, MA 02021
A member, or authorized representative(s) acting on behalf of a member, may request an appeal for any decision made by Harvard Pilgrim to deny coverage for health services. This applies to (a) health services already received (i.e., denied claim); and, (b) requests to authorize coverage for services in advance (i.e., denied pre-authorization or prior approval).
A request for an appeal must be submitted within 180 days of the date of service, or within 180 days from the date payment for a service is denied by Harvard Pilgrim. Appeals submitted beyond the 180-day time frame will not be accepted for review.
To process your appeal request, we will need some specific information from you. Here’s what is important to include:
All appeals are reviewed and responded to in accordance with all state, federal and National Committee for Quality Assurance (NCQA) guidelines
Requests for appeals may be submitted to Harvard Pilgrim in person, by mail or by fax to:
Harvard Pilgrim Health Care
Appeals & Grievances Department
1 Wellness Way
Canton, MA 02021
Open weekdays 8:30 a.m. – 5 p.m.
Fax: (617) 509-3085
To request an appeal by phone, call Harvard Pilgrim’s Member Services department at (888) 333-4742. For TTY service, call 711.
Representatives are available Mondays, Tuesdays and Thursdays 8 a.m. - 6 p.m.;
Wednesdays 10 a.m. - 6 p.m.; and Fridays 8 a.m. - 5:30 p.m.
Appeals concerning behavioral health services must be submitted to:
Harvard Pilgrim Behavioral Health Access Center
c/o United Behavioral Health
Appeals Department
P.O Box 30512
Salt Lake City, UT 84130-0512
Tel: (888) 777-4742 Fax: (855) 312-1470
If you have additional questions about the appeal process, please refer to the Appeals and Complaints section of your Benefit Handbook or contact Member Services.
These Terms of Service govern the Harvard Pilgrim Health Care Chatbot portal (“Portal”). Before you use or access the Portal, you must carefully review these Terms of Service (the "Terms"). In addition, specific pages on our website or mobile application (the “Services”) may set out additional terms and conditions, all of which are incorporated by reference into these Terms. These Terms may be changed or updated at any time, but you can always find the most recent version here. If we make material changes to the Terms, we will notify you through our services or by other means. You should periodically check this page to make sure you are up to date.
By using the Portal, you indicate that you accept these Terms and that you agree to be bound by them. Acceptance of these Terms creates a binding contract between you and Harvard Pilgrim Health Care that you will use the Services only in a manner consistent with these Terms.
Responsibility of the Host
You understand that the Portal administrator/owner shall have the right, but not the obligation, to monitor, edit, move, delete or refuse to post any content, or part thereof, in order to determine and/or ensure compliance with these Terms, applicable law and any other operating rules that may be established by the administrator/operator from time to time.
The administrator/owner will manage access to the Portal, including, but not limited to, adding and removing users of the Portal, changing user’s settings, or responding, in a timely manner, to inquiries related to the Portal or its use. The administrator/owner may, in its sole discretion, terminate or modify your access to the Portal. You may not use the Portal for illegal purposes or in a manner that infringes the rights of any third party, including but not limited to, defamation, violation of intellectual property laws, violation of antitrust or unfair competition laws, or violation of criminal laws.
The Portal is not intended to be used for medical diagnosis or treatment. The Portal should not be used for any such purpose. If you think that you are having a medical emergency, call 911 or the number for your local emergency service.
The Portal is a computer program that mimics chatting with a person. The Portal responds to your questions through a pre-programmed knowledgebase to identify best fit related answers. The Portal is designed to be used by members enrolled in certain commercial products offered by Harvard Pilgrim Health Care. It is not intended for use by Medicare members, employers, health care providers or brokers. The Portal is not intended to answer your plan specific questions or any questions relating to your personal health information. The knowledgebase of the Portal should expand over time. Portal responses may not be accurate. Please see Limitation of Liability.2
It is usually acceptable to include a link to an article, while copying and pasting the actual article may be in violation of copyright laws.
Rule 1: Do not use the Portal for illegal purposes, including but not limited to defamation, violation of intellectual property laws, violation of antitrust or unfair competition laws,3 or violation of criminal laws. Do not use the Portal if you are under 18 years of age or the age of majority under applicable law.
a. Copyright — Referring to an article or news item with typical reference citations, providing a brief quote, or offering a link to legitimate online published content is permissible; members should not post a full-text version of published material to the Portal. Not infrequently a member wants to tell others about an article or news item related to the issues discussed. However, sending the entire article, without the permission of the author or publisher, results in a prima facie case of copyright violation. While there can be defenses to a claim of copyright infringement where the purpose of copying is clearly not for commercial purposes (e.g. “fair use” or academic teaching exceptions), those defenses are complicated, have been construed differently in different jurisdictions and may not be applicable.
b. Defamation and libel — In exchanges on the Portal and when referring to others, avoid personal attacks and characterizations that question a person’s motives or qualifications. Sometimes a robust debate about ideas spills over into attacks on the proponents or opponents of the ideas. Members need to be reminded that a false statement that harms someone's reputation can be actionable as libel.
c. Prohibited uses — By using the Portal, you agree not to submit, post, or transmit any material or otherwise engage in any conduct that:
Rule 2: Do not intentionally interfere with or disrupt other members, network services or network equipment. This includes distribution of unsolicited advertisement or chain letters, propagation of computer worms and viruses, and use of the network to make unauthorized entry to any other machine accessible via the Portal.
Rule 3: Do not use the Portal for commercial purposes. "Commercial" means communications whose primary purpose is to advance the business or financial interests of any person or entity, or otherwise to promote a financial transaction for the benefit of the author directly or indirectly. Examples of prohibited communications include advertisements for products or services or direct solicitations of members to purchase products or services.
Examples of messages that may be of financial benefit to members but are not prohibited because they do not inure to the financial benefit of the author include news of job listings or position openings, or discussion of professionally related products or services where the member conveying the information is not in the business of selling the products or services.
Rule 4: Do not use this Portal for any communication that could be construed in any way as support for or opposition to any candidate for a federal, state or local public office.
If you have any questions, concerns or problems with regard to the Portal, please feel free to contact us at the email or mailing address below.
Email: harvard_pilgrim_online@harvardpilgrim.org
Mailing Address:
Harvard Pilgrim Health Care
Digital Department
1 Wellness Way
Canton, MA 02021
Harvard Pilgrim Health Care, Inc., along with our partners, supplies all information posted on this website. While we try to maintain only current and accurate information, we disclaim any implied warranty or representation about its accuracy or completeness, or appropriateness for a particular purpose. As the recipient of this information, you assume full responsibility for using the information on this website, and you understand and agree that Harvard Pilgrim is neither responsible nor liable for any claim, loss or damage resulting from its use.
The mention of specific products or services at this site does not constitute or imply a recommendation or endorsement by Harvard Pilgrim, unless it is explicitly stated. The views and opinions of authors do not necessarily state or reflect those of Harvard Pilgrim. This website may provide specific health information, none of which is intended to be specific to your health or medical condition. Nothing contained, expressly or implied, on this site is intended or shall be construed as medical or other professional advice by Harvard Pilgrim.
For specific medical advice, diagnosis and treatment, contact your health care provider.
If you are a Harvard Pilgrim member and have questions about your coverage, call Member Services at (888) 333-4742, for TTY service, call 711.
This website may contain links to other websites for your convenience. However, Harvard Pilgrim disclaims any responsibility for the content, information or the privacy and security protections or policies contained on those other websites, and does not exert any editorial or other control over those sites.
When we link to the sites of Harvard Pilgrim vendors where protected information (PHI) is collected on our behalf, those sites are required to safeguard information in accordance with HIPAA.
Harvard Pilgrim does not expressly or implicitly recommend or endorse the specific services or products referenced at other websites linked to Harvard Pilgrim's site, unless explicitly stated. The services, products, or providers on this site linked websites, or in listings of network doctors and hospitals may not be covered in your specific benefit package or included in your provider network. We offer this information to be comprehensive, but it is not linked to your benefits plan. You must consult your specific benefits plan materials, provider network or contact Member Services at (888) 333-4742 (for TTY service, call 711) if you have any questions.
1 Harvard Pilgrim Health Care includes: Harvard Pilgrim Health Care, Inc., Harvard Pilgrim Health Care of New England, Inc., HPHC Insurance Company, Inc., Point32Health Services, Inc. Group Health Plan, and self-funded plans administered by these entities.
2 Limitation of Liability: You agree that your use of the portal is at your sole risk. Because of the number of possible sources of information available through the portal, and the inherent hazards and uncertainties of electronic distribution, there may be delays, omissions, inaccuracies or other problems with such information. If you rely on the portal or any material available through the portal, you do so at your own risk. You understand that you are solely responsible for any damage to your computer system or loss of data that results from any material and/or data downloaded from or otherwise provided through the portal.
The portal is provided to you “as is,” with all faults, and as available. The portal, harvard pilgrim health care, and its officers, employees, agents, affiliates, subsidiaries and related companies (“released parties”) cannot and do not warrant the accuracy, completeness, currentness, non-infringement, merchantability or fitness for a particular purpose of the information available through the portal, nor do they guarantee that the portal will be error-free or continuously available, or that the portal will be free of viruses or other harmful components. Under no circumstances will the released parties be liable to you or anyone else for any damages arising out of use of the portal, including, without limitation, liability for consequential, special, incidental, indirect or similar damages, even if we are advised beforehand of the possibility of such damages. (because some states do not allow the exclusion or limitation of certain categories of damages, the above limitation may not apply to you. In such states, the liability of the released parties is limited to the fullest extent permitted by such state law.)
Your sole and exclusive remedy for any dispute arising from or in any way connected to your use of the portal is to discontinue your use of the portal or any service offered by the released parties.
3 Intellectual Property: You understand that by posting or submitting content on or via the Portal, you are granting to Harvard Pilgrim Health Care a royalty-free, perpetual, irrevocable, non-exclusive, unrestricted, assignable, sublicensable, worldwide license to display, use, copy, modify, transmit, sell, exploit, create derivative works from, distribute and/or publicly perform such content, in whole or in part, in any manner or medium, now known or hereafter developed, for any purpose. The foregoing grant shall include the right to exploit any proprietary rights in such content, including, but not limited to, rights under copyright, trademark, service mark or patent laws under any relevant jurisdiction.
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