Health Plan Participation by Product

Listing of Health Plans by Product

Below is a list of payors and products NEPHO participates in either directly or via the Lahey Clinical Performance Network (LCPN). [Note: some NEPHO specialists may have a primary affiliation with another risk unit that has different contractual arrangements.]

To print the entire grid please click here Plan Participation Grid.  The document is set to print on legal size paper.

Blue Cross Blue Shield of Massachusetts (BCBSMA)

Plan Type Product Type or Name PHO Contract?
Commercial HMO Yes
Commercial POS Yes
Commercial PPO/EPO Yes
Medicare Adv HMO* Yes**
Medicare Adv PPO Yes**

*Some PCPs are excluded
**Physician participation is optional

Boston Medical Center (BMC) Healthnet

Plan Type Product Type or Name PHO Contract?
MassHealth MassHealth Yes**
MassHealth CarePlus Yes**
QHP ConnectorCare Yes**
QHP Silver Yes**
QHP Bronze No
QHP Gold No
QHP Platinum No

**Physician participation is optional

Cigna

Plan Type Product Type or Name PHO Contract?
Commercial All Yes

Commonwealth Care Alliance (CCA)

Plan Type Product Type  PHO Contract?
Dual Elig (>65) One Care No
Dual Elig (65+) SCO Yes**

**Physician participation is optional

Fallon

Plan Type Product Type or Name PHO Contract?
Commercial Direct Yes
Commercial Select Yes
Commercial PPO Yes
Commercial Tiered Choice Yes
Commercial Steward Comm No
Dual Elig (>65) Total Care No
Dual Elig (65+) Navicare SCO No
Medicare Adv HMO No
Medicare Adv PPO No
QHP Comm Care No
PACE Summit No

Harvard Pilgrim Health Care (HPHC)

Plan Type Product Type  or Name PHO Contract?
Commercial HMO Yes
Commercial POS Yes
Commercial PPO/HPI Yes
Commercial GIC HMO Yes
Commercial GIC POS Yes
Commercial National Yes
Commercial Focus Yes***
Commercial Tiered Plans Yes***
Commercial ElevateHealth No
Commercial BMC Select No
Medicare Sup Supplement Yes
Medicare Sup Enhance Yes
Medicare Adv Stride* Yes

*Some PCPs are excluded
***All NEPHO PCPs included as well as Specialists who are Primary with NEPHO

Tufts Health Plan (THP)

Plan Type Product Type or Name PHO Contract?
Commercial HMO Yes
Commercial POS Yes
Commercial PPO/EPO Yes
Commercial GIC Navigator Yes
Commercial GIC Spirit Yes
Commercial Select Network Yes***
Commercial Steward Employee No

***All NEPHO PCPs included as well as Specialists who are Primary with NEPHO

Tufts Health Public Plans (THPP)

Plan Type Product Type or Name PHO Contract?
MassHealth Together Yes
QHP ConnectorCare Yes
QHP Direct Platinum Yes
QHP Gold Yes
QHP Silver Yes
QHP Bronze Yes
Dual Eligible (>65) Unify No

Tufts Medicare Preferred (TMP)

Plan Type Product Type or Name PHO Contract?
Medicare Adv TMP Yes*
Dual Eligible (65+) Tufts SCO Yes*

*Some PCPs are excluded

UniCare

Plan Type Product Type or Name PHO Contract?
Commercial PPO Yes
Commercial Indemnity Yes