Medical Benefits

Benefits can vary by plan. Always check your Plan Information to confirm benefit coverage.

Preventive/Routine Care - Staying Healthy

• Physical Exams (Check-ups)
  NHP covers routine physical exams as appropriate to the member's age and sex. Your Primary Care Provider must arrange all routine examinations.
  
• Allergy Shots, Flu Shots, and other Vaccinations (shots)
  Covered as part of office visit. Additional information about vaccinations, including printable immunization charts can be found here.
• Eye Care/Exams
  Routine exams are covered for all members (frequency limits may apply - check your plan info). Eyeglasses or contact lenses are not covered through NHP. MassHealth members have coverage for eyeglasses directly through MassHealth. Commonwealth Care members have their vision care benefit managed by OptumHealth.
• Family Planning, OB/GYN and Maternity Care, Prenatal-Postanatal Care
  Routine Exams and Maternity Care are covered - no referral is necessary. Limits or exclusions for abortion, family planning or infertility treatment may apply to your plan.

Nurse Advice Line

NHP Members have access to a Registered Nurse 24 hours a day, 7 days a week. You can call or email about any health concern that you have, large or small. This service is free for all NHP members.

Referrals and Authorizations

Learn more about referrals and authorizations for services and specialty care covered by NHP.

Diagnostic and Treatment Services - When you are sick

• Specialty Visits
  In most cases, specialty visits are covered without a referral from your Primary Care Provider(PCP). If your PCP is affiliated with Harvard Vanguard Medical Associates(HVMA), you are required to obtain a referral if you choose to receive medical care from an NHP specialist who is not affiliated with HVMA.
• Urgent Services (visits due to illness)
  Covered if arranged by your Primary Care Provider.
• Emergency Services
  Covered for all members. Your Primary Care Provider should be notified within 48 hours.
• Hospital Care
  Covered if arranged by your Primary Care Provider.
• Home Health Care
  Covered if arranged by your provider.
• Lab Tests
  Covered as part of office visit or inpatient treatment.
• Durable Medical Equipment
  Covered for most members - please check your plan information for coverage details.

Other Forms

• If you have paid for a covered service from provider who does not participate with NHP, use this form to file a claim for reimbursement.
  Member Reimbursement Claim Form