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Primex3Health

Provider Network and Member Services Brought to Youby Harvard Pilgrim Health Care of New England

Frequently Asked Questions

  1. Can I keep my doctor?

    2. Our network of doctors and specialists includes New Hampshire, Maine and Massachusetts, as well as parts of Vermont and Rhode Island. To learn if your doctors are participating, check the provider directory, or for the most up-to-date list of doctors go to: www.harvardpilgrim.org.

    Click on FIND A DOCTOR and select the appropriate plan option under the drop down menu when searching for providers.

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  2. I know that my local doctors are part of the network, but will I be covered when I am traveling out of New England?

    3. Members are covered for urgent and emergent care when you are outside the service area. In addition, Harvard Pilgrim has an extensive national network of pharmacies, which work in any part of the country.

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  3. What about the network for when my kids are in college in another state?

    4. Students out of the service area are covered for urgent and emergent care, as well as pharmacy services. They must receive routine care back in the service area. Examples of routine care include yearly physicals and routine OB/GYN care.

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  4. I am currently being treated for an ongoing condition. How will this be treated during the transition from my current insurance?

    5. Ongoing care should be seamless; Harvard Pilgrim will assign a case manager to assist anyone with serious ongoing conditions, such as Cancer, or other serious ongoing health issues. If you are seeking care from a specialist at the time of transition, you will need to seek a new referral from your PCP for continued care to be covered by Harvard Pilgrim.

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  5. Will the transition be smooth when switching to Primex3Health?

    6. The sooner we begin the process the better the likelihood of a smooth transition. For those who need additional or special attention, a Harvard Pilgrim case manager will be assigned to help with the transition. A checklist for all employees will be provided to assist with prompt notification of their doctors, for referrals, and to re-write prescriptions. However, if something were to arise during the transition, Harvard Pilgrim Member Services at 1(888)-333-HPHC (4742) will help with specific questions or issues.

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  6. I currently use a mail order or web based prescription service. Does Primex3Health offer the same member service?

    7. Both mail in and web-based prescriptions services are available to you. The difference is that Tier One drugs, which includes most of the generics, under the Primex3Health plans have a $0 co-pay. This would be for both at the pharmacy, or for a three month supply for both the mail-in and web-based service.

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  7. With my current plan, I only have access to Massachusetts doctors and hospitals as an out of network benefit, what does Primex3Health offer?

    8. All Primex3Health plans include most Massachusetts doctors, specialists, and teaching hospitals as in-network participating providers... even on the HMO.

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