This in-network plan provides a moderate co-payment option and 80% coverage on some provider services after you meet your deductible. It offers prescription drug coverage and vision benefits and has mid-level monthly premiums.
- Benefits handbook: basic (PDF)
- Summary of benefits: basic (PDF)
- Schedule of benefits: basic (PDF)
- Prescription drug brochure (PDF)
- Summary of prescription benefits: basic (PDF)
- Three-tier prescription: basic (PDF)
- Legal notices for group members (PDF)
- Harvard Pilgrim Notice of Privacy Practices (PDF)
- Preventive services under the ACA (PDF)
- Wrap Summary Plan Description (PDF)
Plan Costs
Full-Time Basic Coverage
|
|
12-Month Pay Structure |
9-Month Pay Structure |
|---|---|---|
|
Single |
$87.99 | $117.32 |
| One Parent & Children | $220.21 | $293.61 |
| Two Adult | $389.28 | $519.04 |
| Family | $398.18 | $530.91 |
Half-Time Basic Coverage
|
|
12-Month Pay Structure |
9-Month Pay Structure |
|---|---|---|
|
Single |
$131.23 | $174.97 |
| One Parent & Child/ren | $664.02 | $885.36 |
| Two Adult | $925.36 | $1,233.81 |
| Family | $1,020.60 | $1,360.80 |
Health Online
Create an account with Harvard Pilgrim online to access information about your medical health plan.
Other Resources
- Health Advocate: Utilize this free and confidential service to compare the three plans to help choose the plan appropriate to you.