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Harvard Pilgrim HMO LP

Harvard Pilgrim Best Buy HMO LP offers high-quality coverage at a more affordable premium than a traditional HMO.

You’ll choose a primary care provider (PCP).

You'll be charged co-payments for office visits.

You’ll be subject to an annual deductible.

After the deductible services may be subject to coinsurance or a co-pay. (Refer to the Schedule of Benefits).

Services provided by Low Cost Providers for Labs and Outpatient Surgical procedures are at a minimal cost.

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

Prescriptions Drugs have a co-payment 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 (Behavioral Health Providers). DoD provides treatment for 90% of the most common health conditions affecting the mind and body.

Under this plan your DoD (including Optum) co-pay 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

No Charge

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



NH Staff/CGPS Faculty (12 mos)     NH Staff (10 mos)     RFF (12mos/8mos)

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:


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