Back to Insights and Updates for ProvidersMay 2024

GIC product updates effective July 1

Harvard Pilgrim Health Care Commercial

Point32Health is offering a reminder for our provider network that the 2024-2025 plan year for our Harvard Pilgrim/Group Insurance Commission (GIC) products begins on July 1, 2024. These custom Commercial products — Harvard Pilgrim Quality HMO and Harvard Pilgrim Explorer POS — are available for active GIC or eligible municipal enrollees, retired GIC enrollees not eligible for Medicare, retired municipal teachers, and certain other government retirees:

Harvard Pilgrim Quality HMO — Harvard Pilgrim Quality HMO is a tiered limited-network HMO, open to Massachusetts residents (except in Martha’s Vineyard, Nantucket, and Cape Cod). This plan includes a deductible, lower PCP copayment, two copayment tiers for specialist office visits, and two copayment tiers for inpatient admissions to acute care hospitals. Because Harvard Pilgrim Quality HMO is a limited-network product, some of Harvard Pilgrim’s contracted providers do not participate in the Quality HMO network, so it is important to confirm network participation before a Quality HMO member receives treatment.

Harvard Pilgrim Explorer POS — Harvard Pilgrim Explorer POS is a tiered full-network product, open to state and municipal employees in Massachusetts, Connecticut, Rhode Island, Vermont, Maine, and New Hampshire, that allows members to seek in-network medical care (from their PCP or from Harvard Pilgrim participating providers with a PCP referral) or out-of-network medical services (from non-participating providers or Harvard Pilgrim participating providers without a PCP referral). Harvard Pilgrim Explorer POS offerings include a deductible, three lower-cost copayment tiers for PCPs, and three copayment tiers for specialist visits and inpatient admissions to acute care hospitals.

For the 2024-2025 plan year, we used the same methodology to determine tiers as employed previously, and in the vast majority of cases providers’ tiers will remain unchanged. Providers outside of Massachusetts were not included in the tiering analysis, and default to Tier 2 for both products.

For additional product details, please refer to the Tiered Network Plans section of the Learn About Our Products page on the Harvard Pilgrim provider website, as well as the Fast Facts for Hospitals and Professional Providers document.

Audrey Kleinberg,
Director, Provider Relations & Communications

Annmarie Dadoly,
Senior Manager, Provider Communications

Joseph O’Riordan, Susan Panos, Ellen Gustavson, Ryan Francis, Stephen Wong,

Kristin Edmonston,
Production Coordinator

Kristina Cicelova,
Graphic Designer