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Harvard Pilgrim outlines three non‑Medicare plan options for Group Insurance Commission members
Summary
Harvard Pilgrim Healthcare presented three non‑Medicare plan choices for Group Insurance Commission (GIC) members—Explorer POSOS, Quality HMO and Access America—detailing geographic eligibility, network rules, PCP/referral requirements and the deductible levels for individual and family coverage.
Harvard Pilgrim Healthcare presented an overview of non‑Medicare plan options available to active Group Insurance Commission (GIC) members and highlighted the differences members should consider when choosing coverage. The presenter identified three primary plans—Explorer POSOS, Quality HMO and Access America—and summarized geographic eligibility, network structures and deductible levels.
Explorer POSOS is available to members who live in Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island or Vermont. The presenter said Explorer uses a tiered provider network (Tiers 1–3), requires a primary care provider and referrals for in‑network benefits, and carries deductibles of $500 for individual plans and $1,000 for family plans for both in‑ and out‑of‑network care.
The Quality HMO, the presenter said, is limited to mainland Massachusetts (excluding Cape and Islands). That plan uses a narrower network limited to Tier 1 and Tier 2 providers, requires a PCP and referrals, and provides out‑of‑network benefits only for emergencies. Deductibles for Quality HMO were listed at $400 for individual plans and $800 for family plans.
Access America serves members who live outside the six New England states listed above. According to the presenter, Access America provides a national network through a joint venture with United Healthcare, does not use tiering, and relies on flat copay amounts; a primary care provider is recommended but not required. Deductibles for Access America are $500 for individuals and $1,000 for families for both in‑ and out‑of‑network services.
The presenter directed members seeking details—plan highlights, provider directories, exclusions and cost estimates—to Harvard Pilgrim’s GIC resource page at harvardpilgrim.org/gic. The presentation did not include comparative premium amounts or specific provider directories; those items were referenced as available on the website.
