Member resources

On April 17, 2023, Point32Health, the parent organization of Harvard Pilgrim Health Care and Tufts Health Plan, identified a cybersecurity ransomware incident that  impacted our Harvard Pilgrim Health Care systems. The system limitations affect our Harvard Pilgrim Health Care commercial and Medicare Advantage Stride℠ (HMO)/(HMO-POS) plans. (Tufts Health Plan, Tufts Medicare Preferred, Tufts Health Public Plans and CarePartners of Connecticut systems have not been affected.)

As of June 21, 2023, most systems are back online, including the member, employer and broker portals, enrollment, claims and billing. Additionally, our service centers and support teams are at full capacity, and the public website has been restored.

Data latency may impact users’ ability to view the most up-to-date enrollment, eligibility and claims data. We will be working to bring information up to date over the coming weeks.

Effective July 24, 2023, we are resuming normal operations for prior authorization (PA) for all non-pharmacy medical and behavioral health benefits for Harvard Pilgrim Health Care members. As this process is reinstated, we are dedicated to ensuring uninterrupted access to medically necessary services, and we are committed to working with you to minimize disruption to ongoing care. We will continue to support our members’ care in alignment with our continuity of care policy and applicable regulatory requirements.

Please note that the authorization process for pharmacy benefit and medical benefit drugs will continue to operate as normal.

If you have questions, please reach out to your provider and/or our Member Services teams.

This outage should not affect your ability to receive medical services. If you have an urgent need and are having difficulty accessing care and services, please call Member Services.

You can purchase Individual and family coverage through state exchanges or directly from us.  Please visit the following websites to access an exchange:

Maine: https://www.coverme.gov/
New Hampshire: https://www.healthcare.gov/
Massachusetts: https://www.mahealthconnector.org/

To contact us directly for individual and family coverage in Massachusetts, Maine or New Hampshire,  please email [email protected].

Yes. Your secure online account is now available. You will need to reset your password the first time you log in to your online account. Your privacy is important to us, and changing your password from time to time can help keep your information secure.

Please note that some of your dashboard details may not be current due to our recent system outage.

You will need to reset your password the first time you log in to your online account. Your privacy is important to us, and changing your password from time to time can help keep your information secure.

Your claims information may not be current due to our recent system outage. Please check your secure online account over the next few weeks as we bring your account information up to date.

Information about your plan and covered dependents may not be current due to our recent system outage. Please check your secure online account over the next few weeks as we bring your account information up to date.

Your claims and spending information may not be current due to our recent system outage. Please check your secure online account over the next few weeks as we bring your account information up to date.

Information about your plan may not be current due to our recent system outage. Please check your secure online account over the next few weeks as we bring your account information up to date.

We are reinstating our normal billing and payment terms starting with July 2023 invoices for members who buy coverage directly from Harvard Pilgrim and Medicare Supplement members. These invoices include June and July premiums.

We will also reinstate normal billing and payment terms starting with August invoices for members who buy coverage through the Maine and New Hampshire exchanges. These invoices include June, July and August premiums.

Please note, during the system outage, no HPHC members or groups have been terminated due to a lack of payment

Please contact Member Services if you are experiencing financial hardship.

Note: Harvard Pilgrim Health Care Medicare Advantage Stride (HMO) (HMO/POS) members have been able to pay their monthly premiums as they normally do.

For members who buy coverage directly from Harvard Pilgrim and Medicare Supplement members: May and June premium payment due dates were extended to July 1, 2023.

For members who buy coverage through the Maine or New Hampshire exchanges: The May premium due date was extended to July 1, 2023. Please note: June, July and August premiums are due August 1, 2023.

Please contact Member Services if you are experiencing financial hardship.

Note: Harvard Pilgrim Health Care Medicare Advantage Stride (HMO) (HMO/POS) members have been able to pay their monthly premiums as they normally do.

Members who buy their coverage directly from Harvard Pilgrim or through the Maine and New Hampshire exchanges and Medicare Supplement members can pay their premium invoice through our online payment portal (log in to your account) or by check or wire transfer.

Harvard Pilgrim Health Care Medicare Advantage Stride^sm (HMO) (HMO/POS) plan members can pay premium bills as they normally do.

Please contact Member Services for an update on the status of your refund.

For those who buy coverage directly from Harvard Pilgrim Health Care and Medicare Supplement members enrolled in AutoPay, payments for May premium invoices were taken on June 12, 2023. Payments for June and July premiums were taken on July 3, 2023.

For those individuals who buy through the exchange in either Maine or New Hampshire and enrolled in AutoPay, payments for May premium invoices were taken on June 12, 2023. Payments for June, July and August premiums will be withdrawn on or around August 1, 2023.

All payments received during the outage will be processed prior to running automatic payments. If you paid your premium by check, nothing will be deducted from your account. Harvard Pilgrim Health Care Medicare Advantage Stride^SM (HMO)/(HMO-POS) members can pay premium bills as they normally do.

You can submit a request for reimbursement of out-of-pocket expenses through your secure member account.

Yes. You can submit reimbursement requests through your secure member account. Requests can be submitted electronically or by downloading and returning a completed paper form (available in your online account). As a reminder, subscribers may submit their 2023 reimbursement requests up until March 31, 2024, or December 31, 2024, depending on their specific plan.

For those who buy directly or have a Medicare Supplement plan: You should have received a paper bill around June 15, 2023, via U.S. mail. The payment due date was July 1, 2023; automatic payments were withdrawn on July 3, 2023. The bill included the June and July premiums. If you are signed up for an automatic monthly ACH payment, the two-month premium was automatically withdrawn from your account.

For those who purchase through the Maine or New Hampshire exchanges: You will receive a paper bill between July 7 and July 15, 2023. The bill will include the June, July and August premiums, and the payment due date will be August 1, 2023. If you are signed up for an automatic monthly ACH payment, the three-month premium will be automatically withdrawn from your account on or around August 1, 2023.

Yes. All payments received since April 14, 2023, will be reflected on your invoice. Any balance due will be for current premium charges.

If you terminated your coverage effective April 30 or May 31, 2023, you will receive a July invoice as we have been unable to process the coverage termination during the system outage. We will have completed the processing of all enrollment transactions; your August invoice will reflect an adjustment for your terminated coverage.

Please be aware that depending on your effective date as a new Medicare Supplement member, the bill you receive for August may include premiums for more than one month.

• Members with a May 1, 2023, effective date will receive an invoice for May, June, July and August premiums
• Members with a June 1, 2023, effective date will receive an invoice for June, July and August premiums
• Members with a July 1, 2023, effective date will receive an invoice for July and August premiums
• Members with an August 1, 2023, effective date will receive an invoice for the August premium

You can pay your premium online through our payment portal. Please visit www.harvardpilgrim.org to create a secure member account and set up online payment.

You can also mail a check and payment coupon to:
Harvard Pilgrim Health Care
P.O. Box 970040
Boston, MA 02297-0040

Your June and July premium payments were withdrawn from the account on file on July 3, 2023. Normal monthly premium withdrawals via AutoPay will resume in August.

Call Member Services at 877-907-4742 (TTY: 711). Representatives are available Mondays, Tuesdays and Thursdays from 8 a.m. to 6 p.m.; Wednesdays from 10 a.m. to 6 p.m.; and Fridays from 8 a.m. to 5 p.m.