As a reminder, as of June 1, 2026, providers who have opted out of Medicare and are providing services to members of Harvard Pilgrim Health Care Commercial, Medicare Enhance, or Medicare Supplement with Medicare as their primary insurance are now required to submit an opt-out form with their claim. 

You can complete and submit this Harvard Pilgrim form with each claim by mail to:

Harvard Pilgrim Health Care 
P.O. Box 699183 
Quincy, MA 02269-9183

By completing and submitting the form, the provider acknowledges that they have opted out of Medicare and does not receive any direct or indirect Medicare payment for services furnished to Medicare beneficiaries.

Submission of this form does not guarantee reimbursement as services are reimbursed based on the Plan’s coverage. If the provider fails to submit the form with their claim, the claim will be denied.