Insurance rates for Health, Dental, and Vision, 2013 >>

HEALTH INSURANCE
Employees are offered a choice of two medical insurance plans through Tufts Health Plan: an HMO, an Advantage (Low Cost) HMO and a PPO. The cost of this benefit is shared between the College and the employee.

Coverage becomes effective on the first of the month following or coincident with the date of hire. Employees may elect individual, employee plus one, or family coverage. The plan covers non-dependent children up to the age of 26.

Health Maintenance Organization (HMO)
In general, preventive and medically necessary health care services and supplies are covered when provided or authorized by your network primary care provider (PCP). This plan also covers emergency medical care you may need, even when the care is not provided or authorized by your PCP.

As an HMO member:

• You must choose a PCP from the Tufts Health Plan network of providers. 
• In most cases, your network PCP must provide or authorize (provide a referral for) your care. 
• You pay a co-payment at the time you receive covered health care services. 
• There are annual maximums on the number or amount of co-payments you pay for day surgery and inpatient care. 

Please check the HMO Value Choice Copay Summary of Benefits (pdf) for more information.

If you do not already have a PCP who participates in the Tufts Health Plan network, you may find a doctor here.

Advantage (Low Cost) HMO
Like the above HMO, the Low Cost HMO requires selection of a PCP for you and each covered family member. The PCP directs all of your care, including referrals to a specialist when necessary. The plan covers preventive/routine services in full, with no member cost sharing, similar to the HMO and the in-network side of the PPO plan. While the basic structure of the Low Cost HMO mirrors the above HMO, however, there are a couple of important differences to consider:

• The Low Cost HMO requires a modest upfront deductible for inpatient hospital care, day surgery, and certain other outpatient services. After you satisfy this annual deductible, those services subject to the deductible are covered in full. Check the Advantage (Low Cost) HMO Deductible Details Information Sheet (pdf) for a more detailed list of services subject to the deductible.
• Slightly higher copays apply to emergency room visits, doctor's office visits, and visits to specialists, which require referrals by your PCP.

Please check the Advantage (Low Cost) HMO Summary of Benefits (pdf) for more information. Also read through the Advantage (Low Cost) HMO Member Information Sheet (pdf).

Keep in mind that, while these differences may increase your out-of-pocket costs when you receive care under the Low Cost HMO plan, your premium contributions for this plan will be much lower than what you will pay for coverage under the HMO and PPO plans.

Preferred Provider Organization (PPO)
As a PPO member:

• You are not required to choose a PCP. 
• You can seek covered health services from most licensed providers in or out of the Tufts Health Plan network. 
• No referrals are needed. 

Please check the PPO Value Summary of Benefits (pdf) for more information.

Fitness Reimbursement Information
Tufts Health Plan will reimburse you up to $250 for your fitness club membership.
Complete the Member Reimbursement Fitness Club Form (pdf) and return it to Tufts Health Plan.

Monthly Prescription Refills
Do you refill prescriptions monthly? Members with Tufts Health Plan can order prescriptions by mail and refill online to save time and money. This pharmacy benefit is administered by Caremark. Complete the Mail Service Order For m(pdf) and return it to Caremark.

Member Reimbursement
For reimbursement for covered out-of-pocket expenses such as a flu shot, please complete the Member Reimbursement Medical Claim Form (pdf).

Contacting Tufts
To contact Tufts Health Plan member services center, call 800.462.0224 or go online to their website at tuftshealthplan.com.

DENTAL INSURANCE
Employees are offered dental insurance through Delta Dental. This is an employee-paid benefit. Coverage becomes effective on the first of the month following or coincident with the date of hire. Employees may elect individual, employee plus one, or family coverage. The plan covers dependent children up to the end of the month in which they turn 21. Dependent full-time students may be covered up to the end of the month in which they turn 26.

The dental plan covers:

• 100% of preventative services
• 80% of basic restorative services
• 50% of major restorative services
• 50% of orthodontic services up to $1,000 for dependent children under the age of 19

There is a $1,500 (per person) annual maximum for all coverages combined. 

For more detailed information on coverage, please refer to the Dental Benefits Summary (pdf).

For reimbursement for an out of network claim, please complete the Dental Claim Form (pdf).

To contact the Delta Dental customer service center, call 800.872.0500 or go online to their website at www.deltadentalma.com.

Please note: You can pay for out-of-pocket costs associated with dental work using a Flexible Spending Account.

VISION INSURANCE
Employees are offered vision insurance through UnitedHealthcare Vision. This is an employee-paid benefit. Coverage becomes effective on the first of the month following or coincident with the date of hire. Employees may elect individual, employee plus one, or family coverage. The plan covers non-dependent children up to the age of 26.

The vision plan covers: 

• Eye exam once every 12 months
• Lenses once every 12 months
• Frames once every 24 months
• Contacts* once every 12 months

 *(in lieu of lenses and frames)

For more detailed information on coverage, please refer to the Vision Benefits Summary (pdf) and Frequently Asked Questions (pdf). 

For reimbursement for an out of network claim, please complete the Out of Network Claim Form (pdf).

To contact UnitedHealthcare Vision customer service center, call 800.638.3120 or go online to their website at www.myuhcvision.com.

This website is intended as a general overview of Hampshire College benefits plans only. Every effort has been made to summarize these programs accurately. In all cases, the actual provisions of each benefit plan will govern if there is any inconsistency between this site and Hampshire’s formal plans or contracts.