Tools + Resources
Helpful resources to keep you healthy
We’re on a mission to help our members stay healthy. But life gets busy and we know it’s not easy to make healthy lifestyle choices every day. Use the tools and resources here to manage your health so you can live a longer, healthier life. And of course, be sure to talk about all of your health care concerns with your doctor.
Medical necessity guidelines
Medical Necessity Guidelines are developed to determine coverage for benefits, and are published to provide a better understanding of how coverage decisions are made. We make coverage decisions using these guidelines, along with the Member’s benefit document, and in coordination with the Member’s physician(s) on a case-by-case basis considering the individual Member's health care needs.
In certain areas and for certain services, Tufts Health Freedom Plan delegates utilization management. In these situations, delegated vendor guidelines may be used to support medical necessity and other coverage determinations. If you have access to the Cigna PPO network or the PHCS network and plan to seek services from a Cigna or PHCS provider outside of MA/RI/NH then you may be subject to the medical necessity guidelines listed below.
- Tufts Health Freedom Plan guidelines
- Cigna guidelines
- American Health Holdings Medical Necessity Guidelines (PHCS Providers)
If you are seeing a PHCS provider, your provider can call American Health Holdings at 866.415.7143 to obtain an MNG or to request authorization for services on your behalf.
Understanding your healthcare choices
We’ve designed this library of disease and condition content to help you make better health decisions. You can browse health information, check your symptoms and use the decision tools to better understand health procedures, medical tests, and health issues.
Well Member Update
Our member magazine, Well!, is mailed once a year, and features current wellness topics and benefit highlights. View our current edition.
Protection against domestic violence
If you or a family member are in immediate danger, call 9-1-1 at once.
The following resources will help you learn more about domestic violence, including identifying the warning signs, domestic violence laws, and what to do if you or a loved one have been affected:
Children and adults with special needs
Tufts Health Freedom Plan provides benefits explanations and clinical support to members and their dependents that have special needs. To better understand what you’re eligible for, log on to check your benefits, or refer to your Evidence of Coverage (EOC) or member handbook.
In addition, we created a list of organizations which provide support, information, and resources for both people with special health needs and those who care for them: