Plan Information

Tufts Health Plan

Customer Service

Tufts Health Direct Members: 888-257-1985
Tufts Health Premier Members: 800-462-0224
Main: 617-972-9400
TTY: 711

Tufts Health Plan

Offers ConnectorCare Plans

Tufts Health Plan is one of the nation’s most highly rated nonprofit health insurance companies, known for delivering high-quality health care and an outstanding member experience. We offer a broad range of health care plans and coverage options to individuals and employer groups in the region and nationally. We are committed to providing our members with comprehensive health care coverage by contracting with thousands of primary care providers, specialists, hospitals, and community organizations, and by designing innovative tools that help you maintain your health and increase your well-being.

Tufts Health Plan is a leader in managing health care costs, advancing public policy, and designing programs that enhance prevention, wellness, affordability, and accessibility

Mission
To improve the health and wellness of the diverse communities we serve.

Vision
Every life improved through access to high-quality, affordable health care.

Products & Services
Tufts Health Plan offers two different families of individual and small-group plans on the Massachusetts Health Connector — Direct and Premier. Direct offers low-cost ConnectorCare plans and federal premium tax credits to those who qualify. Premier offers access to the Tufts Health Plan standard network.

Direct and Premier plans have different provider networks. Some doctors may be in one network and not the other. Before choosing a plan, make sure your primary care provider (PCP), specialist, and/or behavioral health provider is in-network by using the Provider Search tool.

2019 Plan Information

NCQA Accreditation Star Ratings

Tufts Health Direct

Overall
2.6 out of 4 stars
This is the health insurer’s accreditation score from NCQA. NCQA evaluates the insurer’s quality measures and ongoing improvement.
Access and Service
3 out of 4 stars
NCQA evaluates how well the insurer provides access to needed care and with good customer service. To evaluate these activities, NCQA reviews the insurer’s appeals and denials, interviews the insurer’s staff and grades the results from consumer surveys.
Qualified Providers
3 out of 4 stars
NCQA evaluates the insurer’s efforts to confirm that each doctor is licensed and trained to practice medicine and that the health plan’s members are happy with their doctors. To evaluate these activities, NCQA uses records of doctors’ credentials, interviews the insurer’s staff, and grades the results from consumer surveys.
Staying Healthy
3 out of 4 stars
NCQA evaluates the insurer’s activities that help people maintain good health and avoid illness. To evaluate these activities, NCQA reviews the insurer’s records, grades independently verified clinical data and reviews materials sent to members.
Getting Better
3 out of 4 stars
NCQA evaluates health plan activities that help people recover from illness. To evaluate these activities, NCQA reviews the insurer’s records and interviews the insurer’s staff.
Living with Illness
3 out of 4 stars
NCQA evaluates health plan activities that help people manage chronic illness. NCQA grades independently verified clinical data and interviews the insurer’s staff.

Tufts Health Premier

Overall
3 out of 4 stars
This is the health insurer’s accreditation score from NCQA. NCQA evaluates the insurer’s quality measures and ongoing improvement.
Access and Service
3 out of 4 stars
NCQA evaluates how well the insurer provides access to needed care and with good customer service. To evaluate these activities, NCQA reviews the insurer’s appeals and denials, interviews the insurer’s staff and grades the results from consumer surveys.
Qualified Providers
3 out of 4 stars
NCQA evaluates the insurer’s efforts to confirm that each doctor is licensed and trained to practice medicine and that the health plan’s members are happy with their doctors. To evaluate these activities, NCQA uses records of doctors’ credentials, interviews the insurer’s staff, and grades the results from consumer surveys.
Staying Healthy
3 out of 4 stars
NCQA evaluates the insurer’s activities that help people maintain good health and avoid illness. To evaluate these activities, NCQA reviews the insurer’s records, grades independently verified clinical data and reviews materials sent to members.
Getting Better
3 out of 4 stars
NCQA evaluates health plan activities that help people recover from illness. To evaluate these activities, NCQA reviews the insurer’s records and interviews the insurer’s staff.
Living with Illness
3 out of 4 stars
NCQA evaluates health plan activities that help people manage chronic illness. NCQA grades independently verified clinical data and interviews the insurer’s staff.

About these ratings:
NCQA LogoThe National Committee for Quality Assurance (NCQA) is a private non-profit dedicated to improving health care quality. NCQA accredits and certifies health care organizations and recognizes physicians in key clinical areas. Visit www.ncqa.org to learn more.

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