Southcoast Health Accepted Insurance Carriers and Products For Southcoast Hospitals and Physicians Please call 844-297-2952 with any questions Aetna Products Accepted Aetna Select (Similar to POS) HMO Quality Point of Service (QPOS) Aetna Health Network Only (Similar to PPO) Aetna Open Access Elect Choice (Similar to PPO) Aetna Open Access HMO Open Access Aetna Select (Similar to POS) Aetna Choice POS Aetna Choice POS II Aetna Premier Care Network Choice POS (excludes SHN Neurology, Orthopedic, Cardiology, OBGYN, and General Surgery) Aetna Health Network Option (Similar to PPO) Aetna Open Access Managed Choice (Similar to PPO) Aetna Limited Benefits Insurance Plan (PPO) Open Choice PPO Managed Choice POS Elect Choice EPO Aetna Voluntary Group Medical Plan (Indemnity Plan) Traditional Choice Meritain Health Aetna Medicare Freedom (PPO) - patient can choose any non-par physician Aetna Medicare Plans (HMO/PPO) Aetna of RI Southcoast Physicians Only - Rhode Island providers Products Accepted: Aetna Select (Similar to POS) HMO Quality Point of Service (QPOS) Aetna Health Network Only (Similar to PPO) Aetna Open Access Elect Choice (Similar to PPO) Aetna Open Access HMO Open Access Aetna Select (Similar to POS) Aetna Choice POS Aetna Choice POS II Aetna Health Network Option (Similar to PPO) Aetna Open Access Managed Choice (Similar to PPO) Aetna Limited Benefits Insurance Plan (PPO) Open Choice PPO Managed Choice POS Elect Choice EPO Aetna Voluntary Group Medical Plan (Indemnity Plan) Traditional Choice Products Not Accepted: Aetna Medicare Plans (HMO/PPO) Blue Cross Blue Shield of MA Products Accepted: Please note these products may not be accepted after December 31, 2019 if BCBSMA does not agree to fair and equitable reimbursement for Southcoast Health PPO/EPO HMO Blue HMO Blue Network with Hospital Choice Cost Sharing Feature HMO Blue New England HMO Blue New England Options v.4 HMO Blue New England Options v.5 HMO Blue New England Network with Hospital Choice Cost Sharing Feature HMO Blue Options v.4 HMO Blue Options v.5 Indemnity Medicare HMO Blue Medicare PPO Blue PPO Blue Options v.4 PPO Blue Options v.5 PPO Blue Select Preferred Blue PPO v.4 Preferred Blue PPO v.5 Preferred Blue PPO Network with Hospital Choice Cost Sharing Feature Medex Choice Products Not Accepted: HMO Blue Select (Limited Network) Blue Cross Blue Shield of RI Products Accepted: Basic Blue Basic Blue Direct Access Blue New England BlueChip BlueChip Medicare (Lab Exclusion - Eastside Lab) Blue Chip Advance Blue Chip Extra Blue Chip with Flex Blue Chip without Flex Blue Chip Value HMO Blue Choice New England Blue Solutions Blue Solutions for HAS Blue Solutions Select RI Classic Blue HealthMate Coast to Coast HMO Blue New England Vantage Blue Vantage Blue Direct Vantage Blue Select RI Plan 65 BlueChip for Medicare Advance - Specialists Only Products Not Accepted: BlueChip Direct Advance - New Product 1/1/18 BlueChip for Medicare Advance - PCPs BlueChip for Medicare Advance replaces BlueChip for Medicare Select BMC Healthnet Plan Products Accepted: MassHealth (Includes all new BMCHP Medicaid ACO Plans) MassHealth CarePlus ConnectorCare Plan Types I, II, III Qualified Health Plan (QHP) Silver Wrap Qualified Health Plan (QHP) Silver Non-Wrap Senior Care Options (Effective 3/1/18) Special Kids Special Care Plan (SKSC) Products Not Accepted: Commercial or any Platinum, Gold or Bronze Plans Celticare Southcoast PCPs no longer accept Celticare Can no longer enroll in Plans as of 3/1/2018 MassHealth CarePlus Qualified Health Plan (QHP) Wrap Plans (ConnectorCare/Ambetter) Qualified Health Plan (QHP) Non-Wrap Plans (All Metallic Tiers/Ambetter) Community Care Cooperative (C3) Not contracted but All Southcoast Hospitals and Specialists are accepting this plan. Referral and/or Auth will be required. Fallon Products Accepted: Direct Care Select Care Preferred Care (PPO ) Tiered Choice - Tier 1 Navicare Effective 1.1.17 Products Not Accepted: Senior Plans MassHealth Plans or any of the new Medicaid ACO Plans Steward Community Care Tiered Choice * Currently only offered in Berkshire, Hampden, Hampshire & Worcester counties Harvard Pilgrim Products Accepted: National Plans: Harvard Pilgrim Access America Plans Choice and Choice Plus for Passport Connect Choice Plus and Options PPO Plans Student Insurance Plan PPO Plan HMO Plans: Harvard Pilgrim ChoiceNet Best Buy HMO Plan Harvard Pilgrim Choice Net HMO Harvard Pilgrim HMO & Best Buy HMO Plans with Focus Network Option Focus Network - MA Focus Network - MA Limited Harvard Pilgrim HMO Plan Harvard Pilgrim HMO Plan LP Harvard Pilgrim Hospital Prefer HMO Harvard Pilgrim Core Coverage HMO Harvard Pilgrim GIC Primary Choice Plan HMO Harvard Pilgrim Best Buy HMO Plan Harvard Pilgrim Best Buy HSA HMO Plan Harvard Pilgrim Tiered Copay HMO Harvard Pilgrim Non-Group HMO Plan Net Option HMO Net Option - LP HMO POS Plans: Harvard Pilgrim POS Plan Harvard Pilgrim GIC POS Plan PPO Plans: Choice Net PPO Harvard Pilgrim ChoiceNet Best Buy PPO Plan Harvard Pilgrim PPO Plan Harvard Pilgrim PPO LP Harvard Pilgrim Hospital Prefer PPO Harvard Pilgrim Best Buy PPO Plan Harvard Pilgrim Best Buy HSA PPO Harvard Pilgrim Commonwealth Choice Plans Senior Plans: Medicare Advantage Stride HMO Effective 1.1.17 Harvard Pilgrim Medicare Enhance Plan Harvard Pilgrim Medicare Supplement Plan Harvard Pilgrim continued Plans Administered by Health Plans, Inc: Health Plans, Inc. Employer Specific Plans: Health Plans, Inc. - Southcoast Health Plan Atrius Health Select BIDMC Select HMO BIDMC Choice POS BMC Tiered HMO HP - Lahey Health Select HMO HPHC Plan for Partners Northstar Preferred Care Draper HMO Reliant Select HMO Products Not Accepted: New Hampshire Network HMO Maines Choice HP - Lahey Health Limited HMO BMC Select Elevate Health Stride of New Hampshire (HMO) Innovative Health Plan Participating Provider - SHN (Hospitals and Physicians) Medicaid Participating Provider Individual practices may have their own contract with the Plan. Medicare Participating Provider Multiplan No Network wide contract. SHN Affiliate practices may have their own contract with the Plan. Southcoast Physicians Group is not contracted. Southcoast Hospitals Group is contracted. Neighborhood Health Plan of MA Name Change Effective 1/1/2019: AllWays Health Partners Southcoast PCPs will accept NHP if patient is willing to switch to BMCHP. Participating Provider: Commercial HMO & PPO MassHealth – Transitioning to Medicaid ACO. Neighborhood Health Plan of RI Southcoast Physicians Group (Specialists Only) - Includes Integrity Plan No Hospital Contract or PCP Contract Partners HealthCare Choice Not contracted but All Southcoast Hospitals and Specialists are accepting this plan. Referral and/or Auth will be required. Senior Whole Health Participating Provider Steward Health Choice Not contracted but All Southcoast Hospitals and Specialists are accepting this plan. Referral and/or Auth will be required. TPAs Priority Health Lucent Health General Insurance Service Center Innovative Health Tufts Health Public Plans (Network Health) Southcoast PCP's will accept Tufts Health Together if patient is willing to switch to BMCHP. Products Accepted: Tufts Health Together (MassHealth) - Referral and/or Auth may be required for Hospital and Specialty Services Tufts Health Direct (Connector Plans - see below for list of Plan Names) *Tufts Health Direct ConnectorCare Plan Type I *Tufts Health Direct ConnectorCare Plan Type II *Tufts Health Direct ConnectorCare Plan Type III *Tufts Health Direct Platinum Zero *Tufts Health Direct Platinum 500 *Tufts Health Direct Gold 500 *Tufts Health Direct Gold 1000 *Tufts Health Direct Gold 1500 *Tufts Health Direct Gold 2000 *Tufts Health Direct Silver *Tufts Health Direct Bronze *Tufts Health Direct Catastrophic Tufts Health Extend (Medical Security Program for Unemployed) Products Not Accepted: Choice Plan Tufts Unify Plan (Dual eligible 21-64) Tufts Health RITogether/RI Medicaid THPP Plan Tufts Health Plan Products Accepted: Standard Network Plans: HMO, POS, PPO, and EPO Basic, Value, and Premium Plans Advantage HMO, and PPO, and Saver Medicare Complement Plan Health Pact (RI) Plan Tiered Provider Network Plans: Choice Copay Your Choice 2-Tier HMO, POS, PPO, and EPO Your Choice 3-Tier HMO, POS, PPO, and EPO Lifespan Premier Choice 2 - Tier HMO, PPO, EPO Navigator PPO GIC Plans: Navigator & Spirit (PPO, EPO) Medicare Plan: Tufts Health Plan Medicare Preferred Tufts Health Plan Senior Care Options Effective 1.1.17 National Network Plan: Carelink (MA and RI Plans) Limited Network Plans: Select HMO, EPO, and Advantage HMO Select Other: Christie Student Health - Effective August 2015 Products Not Accepted: Steward Community Choice Tufts US Family - can accept patient if authorized by Payer United Healthcare Products Accepted: UHC Options PPO UHC Select UHC Select HMO UHC Select Plus UHC Charter/Charter Balanced UHC Charter HMO UHC Charter Plus UHC Choice UHC Choice EPO UHC Choice Plus UHC Choice HMO/ Choice Plus HMO UHC All Savers Plans Harvard Pilgrim Options PPO Harvard Pilgrim Choice Harvard Pilgrim Choice Plus UHC Core UHC Core Essential UHC Core HMO/Core Essential HMO UHC Anchor Plans (for State of RI employees) UHC Heritage Plus UHC Heritage Select POS/HMO/EPO UHC Heritage Select Advantage UHC Navigate Plus UHC Navigate/Navigate Balanced UHC Navigate HMO/Navigate Balanced HMO/Navigate Plus HMO UHC Navigate EPO UHC Passport Connect Options PPO UHC Passport Connect Choice UHC Passport Connect Choice Plus UHC Compass Plus (only if member holds an OPEN NETWORK