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Mental Health Authorization Requirements for Senior Products The following grid is intended to clarify when authorization requirements apply depending on the member?s product. Product Tufts Medicare.

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Tufts Health RITogether does not require referrals for specialty care. However, PCPs are responsible for referring members to an in-network specialist, when appropriate.

PHARMACY INFORMATION Tufts Health Plan requires prior authorization for coverage of certain drugs. Tufts Health Plan's pharmacy medical necessity guidelines are used in conjunction with a member's plan document and in coordination with the prescribing provider submitting the request for authorization.

Prior Authorization: Tufts Medicare Preferred HMO requires you or your physician to get prior authorization for certain drugs. This means that you will need to get approval from Tufts Medicare Preferred HMO before you fill your prescriptions.

Tufts Health Plan Spirit is an exclusive provider organization (EPO) plan that covers preventive and medically necessary health care services and supplies. These are services and supplies you need to help you stay healthy or to help you get healthy when you're sick.

As a reminder, while prior authorization is not required for out-of-network services, providers and members are encouraged to request a pre-visit coverage decision from Tufts Health Plan before rendering/seeking out-of- network services.

This is a PPO Plan, so you are not required to designate a Primary Care Provider (PCP) or get a referral for specialty services. However, we encourage you to choose a PCP.

Referral circles In most cases, you must get a referral from your PCP before you see any other health care provider. This means you will not have access to the entire Tufts Health Plan Medicare Preferred HMO network, except in emergency or urgent care situations, or for out-of-area renal dialysis.

Tufts Health Plan Spirit is an EPO plan. It offers the same benefits as the GIC Navigator plan with the following exceptions: • The Spirit provider network has fewer participating providers and hospitals than the Navigator network (i.e., the provider access service area is limited).

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232