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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).

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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