My HR  > My Benefits > Health Plans > PPO LP

My HRMy BenefitsMy CareerMy FormsMy PayMy PoliciesMy ResourcesMy Safety Leadership Toolkit


My Benefits at a Glance


Health Advocate Solutions

Health Plans

Pre-Tax Savings Accounts

Dental Plan

Vision Plan

Short/Long Term Disability
Life and AD&D Insurance

Leave of Absence

Paid Time Off


Tuition Benefit

Medicare/Social Security

Annual Required Notices

Other Perks and Discounts





Harvard Pilgrim PPO LP

Harvard Pilgrim PPO LP offers choice, flexibility and high-quality coverage at a more affordable premium than a traditional PPO.


You are not required to have a primary care provider (PCP) or get referrals for care, and you will be able to receive care from almost any doctor or hospital across the nation using the United Healthcare Network of providers.

You’ll be subject to an annual deductible.

After the deductible services may be subject to coinsurance or a copay.

Emergency and Urgent Care services are covered worldwide in accordance with the benefit plan provisions.

Prescription drugs have a copayment based on a 4 Tier Benefit.

This plan allows you to have a Medical Flexible Spending Account (FSA).

This plan offers Care Management Services in partnership with Benevera Health.

All members have access to telemedicine visits through Doctor on Demand (DoD) and Optum. DoD provides treatment for 90% of the most common health conditions affecting the mind and body.

Under this plan your DoD (including Optum) copay is $25.00.

 Plan Details


Calendar Year Deductible





Calendar Year Out-of-Pocket Maximum (Out-of-Pocket  Maximum Includes Deductible)





Lifetime Maximum


Coinsurance / Copays

Preventive Care


Primary Care Physician

$25 Copay


$50 Copay


Diagnostics X-Ray and Lab

100% after deductible

(Labs covered at 100% at Select LP Providers)

Urgent  Care

Convenience Clinic

Urgent Care Clinic

Hospital Urgent Care



$25 Copay

$50 Copay

$75 after deductible


Emergency Room

$250 after deductible

(waived if admitted)

Inpatient Hospital Care

100% after deductible


Outpatient Surgery

100% after deductible

($100 for Select LP Providers)


Retail RX (up to 30-day supply)

Tier 1


Tier 2


Tier 3


Tier 4


Mail Order  RX (up to 90-day supply)

Tier 1


Tier 2


Tier 3


Tier 4



Arizona Faculty/Staff

Other Tools


For Detailed Plan Documents refer to the links below:

Schedule of Benefits

Summary of Benefits and Coverage

Visit the Harvard Pilgrim Site for additional information:



©2018 Franklin Pierce University
40 University Drive
Rindge, New Hampshire 03461