Medical, dental and vision

This plan provides in-network coverage only. This plan does not have a deductible. Members are not required to select a PCP or obtain referrals for specialist care. In-network providers and facilities include Harvard Pilgrim’s network in Massachusetts, New Hampshire and Maine, and our national partner’s network, UnitedHealthcare Choice Plus, for the remaining states. Members are required to stay in-network with Harvard Pilgrim or UnitedHealthcare for benefit coverage.

Find a Provider
Look Up a Drug

Plan documents

• Schedule of Benefits
• Pharmacy Rider
• Summary of Benefits + Coverage (SBC)
• Benefit Handbook
• To ensure accurate claims processing, give this flyer to providers outside MA/ME/NH
• Sample Member ID Card
   

Additional resources

• Good Measures Healthy Weight program
• Over-the-Counter Medication Flyer
• Premium 4-Tier Pharmacy Flyer
• LGBTQ+ Benefits Guide
• Transgender Services Flyer
• ACA Preventive Care Services Notice
• Notice of Travel Reimbursement
• Travel Benefits Form
• Reduce My Cost
• Know Your Care Options
• Behavioral Health Navigation
• Optum® Home Delivery
• Prescription order form

This plan offers in-network coverage only.  This plan has a deductible.  Members are not required to select a PCP or obtain referrals for specialty care. In-network providers and facilities include Harvard Pilgrim’s network in Massachusetts, New Hampshire and Maine, and our national partner’s network, UnitedHealthcare Choice Plus, for the remaining states. Members are required to stay in-network with Harvard Pilgrim or UnitedHealthcare for benefit coverage.

Find a Provider
Look Up a Drug

Plan documents

• Schedule of Benefits
• Pharmacy Rider
• Summary of Benefits + Coverage (SBC)
• Benefit Handbook
• To ensure accurate claims processing, give this flyer to providers outside MA/ME/NH
• Sample Member ID Card

Additional resources

• Good Measures Healthy Weight program
• Over-the-Counter Medication Flyer
• Premium 4-Tier Pharmacy Flyer
• LGBTQ+ Benefits Guide
• Transgender Services Flyer
• ACA Preventive Care Services Notice
• Notice of Travel Reimbursement
• Travel Benefits Form
• Reduce My Cost
• Know Your Care Options
• Behavioral Health Navigation
• Optum® Home Delivery
• Prescription order form

This plan offers both in-network and out-of-network coverage. This plan has a deductible. The in-network member cost share mirrors the Access America Value with Deductible plan cost share. Members are not required to select a PCP or obtain referrals for specialty care. In-network providers and facilities include Harvard Pilgrim’s network in Massachusetts, New Hampshire and Maine, and our national partner’s network, UnitedHealthcare Choice Plus, for the remaining states. In addition to the Harvard Pilgrim and UnitedHealthcare networks, members may see out-of-network providers, at a higher cost.

Find a Provider
Look Up a Drug

Plan documents

• Schedule of Benefits
• Pharmacy Rider
• Summary of Benefits + Coverage (SBC)
• Benefit Handbook
• To ensure accurate claims processing, give this flyer to providers outside MA/ME/NH
• Sample Member ID Card

Additional resources

• Good Measures Healthy Weight program
• Over-the-Counter Medication Flyer
• Premium 4-Tier Pharmacy Flyer
• LGBTQ+ Benefits Guide
• Transgender Services Flyer
• ACA Preventive Care Services Notice
• Notice of Travel Reimbursement
• Travel Benefits Form
• Reduce My Cost
• Know Your Care Options
• Behavioral Health Navigation
• Optum® Home Delivery
• Prescription order form

This plan offers both in-network and out-of-network coverage. This plan has a deductible and allows you to open an associated Health Savings Account (HSA). Members are not required to select a PCP or obtain referrals for specialty care. In-network providers and facilities include Harvard Pilgrim’s network in Massachusetts, New Hampshire and Maine, and our national partner’s network, UnitedHealthcare Choice Plus, for the remaining states. In addition to the Harvard Pilgrim and UnitedHealthcare networks, members may see out-of-network providers, at a higher cost.

Find a Provider
Look Up a Drug

Plan documents

• Schedule of Benefits
• Pharmacy Rider
• Summary of Benefits + Coverage (SBC)
• HSA Employer Contribution
• Benefit Handbook
• 2025 Preventive Drug List
• To ensure accurate claims processing, give this flyer to providers outside MA/ME/NH
• Sample Member ID Card

Fidelity HSA information

• Guide to understanding a Health Savings Account
• Checklist for using your HSA to its full potential
• HSA Tax Savings Trifecta
• Fidelity HSA Terms and Conditions
• HSA Qualifying Expenses

Additional resources

• Good Measures Healthy Weight program
• Over-the-Counter Medication Flyer
• Premium 4-Tier Pharmacy Flyer
• LGBTQ+ Benefits Guide
• Transgender Services Flyer
• ACA Preventive Care Services Notice
• Notice of Travel Reimbursement
• Travel Benefits Form
• Reduce My Cost
• Know Your Care Options
• Behavioral Health Navigation
• Optum® Home Delivery
• Prescription order form

The Delta Preferred Option USA Plus plan combines two of Delta’s national networks, the Delta Premier Network and the Delta Preferred Network. Employees who use providers in the Preferred network (who generally accept lower payments from Delta) will make better use of the annual maximum benefit.

View rates
View presentation
Subscriber Certificate

Standard option

Eligible dental claims are paid at 100%, 80% or 50%, based on the dental procedure. The annual maximum is $1,500 per member. The plan also includes 50% orthodontic coverage up to a $1,500 lifetime maximum for all plan members. Varying deductibles apply. Coverage options are Individual, Two Person and Family.

For more information about the dental plan please visit the Delta Dental website.

Summary
Orthodontia

High option

Eligible dental claims are paid at 100%, 90% or 60%, based on the dental procedure. The annual maximum is $2,000 per member. The plan also includes 50% orthodontic coverage up to a $2,000 lifetime maximum for all plan members. Varying deductibles apply. Coverage options are Individual, Two Person and Family.

For more information about the dental plan please visit the Delta Dental website.

Summary
Orthodontia

Rollover Max from Delta Dental

A Delta Dental benefit feature that lets you roll over part of your unused spending in one year to increase your benefits for the following year, and beyond.

Learn more about Rollover Max

Additional Delta Dental resources

• Delta Dental Mobile App
• Choosing a Dentist
• Prevent Oral Health Problems
• What to Expect at the Dentist
• Sonic Toothbrush Discount

The EyeMed Vision Care Materials Only plan is a voluntary benefit that offers employees coverage and discounts for lenses, frames, contacts, and Lasik surgery. This benefit is available to eligible employees and is separate from what is offered through the medical plans.

View presentation
View rates

Review coverage and discounts in the EyeMed Vision Care Materials Only Plan (Group #1034377)

Vision exams and discounts

Employees who are Harvard Pilgrim Health Care members are covered for an annual routine eye exam through their medical plan. Please remember to present your member ID at the time of an annual eye exam.

In addition members can use the EyeMed Vision Care Network and eyewear discounts available through the medical plan. View details of the discounts offered through the medical plans.

• EyeMed members-only special offers
• Vision discounts for Harvard Pilgrim members

More from EyeMed

• Freedom Pass
• LASIK savings
• Hearing discount
• EyeMed FAQs

Maven is the world’s largest virtual clinic for women and families that provides around-the-clock care and support for you and your partner. Get access to unlimited 24/7 video appointments and messaging with providers from 35+ specialties, a dedicated Care Advocate to help find the right Maven providers, and hundreds of expert-vetted articles, on-demand classes, and drop-in groups. Maven is included at no cost as part of your Harvard Pilgrim health plan.

Download a flyer

Watch a video

Ovia Health is an individual and family health and wellness program designed to guide a member through some of life’s biggest transitions: planning and starting a family, navigating pregnancy, balancing life as a working parent, and managing menopause.

Family flyer

Menopause flyer

FAQ

Taking a class or course is a great way to build your confidence and prepare for childbirth and early parenthood.

Get reimbursed for childbirth education classes in 2025

Childbirth class reimbursement form

Retiring soon? Learn more about Social Security Benefits and Medicare options.

Presentation Highlights

Social Security

• What is Social Security?
• Social Security benefits
• How work affects filing

Medicare

• What is Medicare? (Eligibility, Enrollment)
• What is covered and not covered
• Deductibles and coinsurance
• Medicare Beneficiary Resource Guide
   

Products

• Medicare Supplements
• Medicare Advantage Plans
• Medicare Prescription Drug Plans (Part D)

Download presentation

Are you or someone you love close to turning 65? Attend these free sessions to learn about benefits available through Social Security and Medicare, hosted by our own Senior Markets experts.

Selecting benefits can be overwhelming. Use HYKE to help you determine which benefits are the best fit for you and your family.

Get started

Email SmartStart at [email protected] to ask questions regarding your medical or pharmacy benefits.

Call SmartStart at 866-874-0817 to discuss your unique complex medical or pharmacy concerns with clinical experts.

Flexible Spending Accounts allow you to make contributions to a special account and not pay federal income tax, Social Security tax and state tax on those contributions. Contributions are conveniently deducted from your paycheck. The health care FSA covers eligible expenses for you and your dependents that are not reimbursed by any medical, dental, vision, or other benefit plan. It is administered by Wex.

Manage your Wex account

How does it work?

• Employees can contribute a minimum of $100 and a maximum of $3,200 per year.
• The amount you choose is evenly deducted from your paychecks throughout the year.
• The entire amount is available for employees to use as of January 1, 2025.
• Health Care contributions made in 2025 may be used until March 15, 2026.
• All claims must be submitted by April 30, 2026.
• An FSA Debit Card is provided for easy access to account funds.
• Any funds left in the FSA account after April 30, 2026, will be forfeited and used to cover the administrative expenses.

Examples of eligible expenses:

• Office visits, hospital and pharmacy co-payments
• Vision expenses (eyeglasses, contacts)
• Dental expenses
• Durable Medical Equipment co-insurance
• Certain over-the-counter (OTC) drugs and medicines with a prescription

Eligible and Ineligible Health Care FSA Expenses

Medical FSA Handout

Flexible Spending Accounts allow you to make contributions to a special account and not pay federal income tax, Social Security tax and state tax on those contributions. Contributions are conveniently deducted from your paycheck. For employees enrolled in the HSA medical plan offered by Point32Health, a Limited Purpose FSA covers eligible expenses for you and your dependents that are not reimbursed for dental or vision expenses only. A Limited Purpose FSA can be used in conjunction with a Health Savings Account. It is administered by Wex.

Manage your Wex account

How does it work?

• Employees can contribute a minimum of $100 and a maximum of $3,200 per year.
• The amount you choose is evenly deducted from your paychecks throughout the year.
• The entire amount is available for employees to use as of January 1, 2025.
• Limited Purpose FSA contributions made in 2025 may be used until March 15, 2026.
• All claims must be submitted by April 30, 2026.
• An FSA Debit Card is provided for easy access to account funds.
• Any funds left in the FSA account after April 30, 2026, will be forfeited and used to cover the administrative expenses.