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Tufts POS

The Tufts Point of Service (POS) option allows choice between two levels of coverage when seeking care:

  1. Authorized Level - A Primary Care Physician (PCP) from the network provides or authorizes all your care (except in an emergency or in certain cases of self-referral). Your PCP will be the primary liaison between you and any specialists you might see within the network. Tufts requires that you call your PCP first when seeking medical services, unless it is an emergency.
  2. Unauthorized Level - Care that is not provided or authorized by your PCP. As such, you are responsible for any applicable deductibles and coinsurance.
  3. As of 1/1/06 the following applies:

Benefits

 General Benefits Authorized (network) Benefits Unauthorized (non-network)
Office Visit - Physical Exam

$20 co-pay

Not covered (unless well child care under the age of 6).
Office Visit - Diagnostic

$20 co-pay

80 percent coverage after $400 deductible for individual; $800 for family
Inpatient Hospital Stay

$200 per admission

80 percent coverage after $400 deductible for individual; $800 for family
Emergency Medical Care

$100 co-pay

80 percent coverage after $400 deductible for individual; $800 for family

Mental Health
Outpatient

Up to 24 visits per calendar year. $20 co-pay

80 percent coverage after $400 deductible for individual; $800 for family
Inpatient

$200 per admission

80 percent coverage after $400 deductible for individual; $800 for family
Pediatric Dental

Not Covered

Not Covered
Chiropractic Services

Annual visit limitation. No referral necessary. $20 co-pay

Participating chiropractors: $20 co-pay, Annual visit limitation. 80 percent coverage after $400 deductible for individual, $800 for family.
Pre-registration for hospital

Required

Not required

Prescription Coverage
Generic

$10

  
Preferred Brand Name

$25

  
Non-Preferred Brand Name

$45

  
Mail order drug program is available.
updated 07/19/06 | 06:10 PM
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