Harvard Pilgrim Health Care is a leading not-for-profit health services company that serves as a guide to better health for its members in Massachusetts, New Hampshire, Maine, Connecticut and beyond. Its flagship health plans in New England provide coverage to more than 1.2 million members, while more than 2 million individuals are served through subsidiaries providing integrated care management and health coaching.

Our mission is to improve the quality and value of health care for the people and communities we serve. We do that through the health plans we offer, as well as through the Harvard Pilgrim Health Care Institute, a research and teaching collaboration with Harvard Medical School; and the Harvard Pilgrim Health Care Foundation, which provides tools, training and leadership to help build healthy communities.

HMO Plans
Health Maintenance Organization (HMO) Plans require Members to select a Primary Care Physician (PCP) from a network of local healthcare providers who will refer you to in-network specialists or hospitals when necessary. All your care is coordinated through that PCP.
Prescription Drug Coverage
  • Options range from very generous to very cost-effective
  • Most Rx plans feature a $0 copayment for Tier 1 medications
  • Mail Order Program: Receive a 90-day supply of your maintenance medications for one low copayment
POS Plans
Point of Service (POS) Plans allow Members to choose a primary care physician (PCP), but can receive care from specialists without their PCP’s referral. In addition, POS members can visit doctors, hospitals and other providers that do not belong to Harvard Pilgrim’s participating provider network.

When provided or arranged by a PCP, services are typically covered in full with copayments. Services received without a PCP referral or outside Harvard Pilgrim’s participating provider network are subject to deductibles and coinsurance.

Medicare Enhance Plans
Expand your options for retiree coverage with Medicare Enhance. This plan provides employer sponsored coverage for people enrolled in Medicare Parts A and B, and is a simple and easy way to transition employees to a retiree plan.
PPO Plans
Preferred Provider Organization (PPO) Plans allow Members to choose to receive care for covered services from providers and hospitals that belong to Harvard Pilgrim’s participating provider network or from those who don’t.
Aetna (PDP)

Expand your options for retiree coverage with the Aetna/SilverScript Prescription Drug Plan (PDP). Paired with the Harvard Pilgrim Medicare Enhance medical coverage, this PDP program is an alternative high quality prescription drug plan for Medicare Retirees.