$1,500/$3,000
Annual Deductible
$3,000/$6,000
Out-of-Pocket Maximum
No charge, no deductible
Primary Care/Office Visit
$50 copay
Specialist Visit
Medical / Rx
Spending & Savings Accounts
Advocacy Support
Dental
Vision
Life & Disability
Voluntary Benefits
EAP
401(k)
Extra Perks
Medicare
Compliance
Glossary
CarrierCorner
Medical Plans
Get access to comprehensive health coverage designed to keep you and your family healthy.
Review plan options, coverage details, and how to enroll.
Review plan options, coverage details, and how to enroll.
Click to schedule time with a Benefits Counselor!
⚠️ Important Rx Formulary Change Beginning 1/1!
Formulary Transition
TPS will move from the Premium 4-tier formulary to the Select 5-tier formulary as part of a cost mitigation strategy across large groups
GLP-1 Coverage
The Select formulary excludes all GLP-1 medications prescribed for weight loss. Coverage for GLP-1s used to treat diabetes remains unchanged.
Tier and Non-Formulary Shifts
Some drugs will change tiers, and some drugs will move to non-formulary status. Impacted members with a drug up-tier change and/or move to non-formulary will be notified by mail 60 days in advance of the change (i.e., by 11/1).
**Members are encouraged to proactively look up their medications in advance of 1/1 on Harvard Pilgrim’s public website by searching the 2026 Select 5-Tier link: https://welcome.optumrx.com/hphcselect5t/landing
Get ready!
Medical Plans are Moving
to Cigna.
Here's how you can get ready for the big switch.
New ID Cards
If you enroll in one of the medical plans, you will receive new Cigna ID cards before the new plan year begins. Use your old card through 12/31.
Confirm Your Information
Confirm your contact information and dependent eligibility during Open Enrollment so your new ID cards are sent to the correct address.
Find an In-Network Provider
Check that your providers are in the Cigna network and update any doctor’s offices or pharmacies with your new ID number when you receive it.
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HSA
FSA
HRA
HSA-Powered High Deductible Plan.
Lower Costs with Coordinated, In-Network Care
This plan offers coordinated care through a network of providers with a low deductible and fixed copays for office visits.
It's a cost-effective choice for those who prefer predictable out-of-pocket costs and are comfortable choosing a primary care provider to manage referrals. You’ll enjoy lower premiums compared to the PPO and solid coverage for routine and preventive care.
$1,500/$3,000
Preventive
Covered at 100%
Tier 1 (Retail/Mail Order)
$5 / $10
Tier 2 (Retail/Mail Order)
$45 / $90
Tier 3 (Retail/Mail Order)
$60 / $120
Tier 4 (Retail/Mail Order)
$100 / $300
HSA
FSA
HRA
$2,000/$4,000
Annual Deductible
$5,000/$10,000
Out-of-Pocket Maximum
$25 copay
Primary Care/Office Visit
$25 copay
Specialist Visit
HSA-Powered High Deductible Plan.
More Provider Flexibility Without Referrals
This plan offers flexibility to see in-network and out-of-network providers without referrals.
While it has higher premiums and a larger deductible than the HMO plan, it provides broader access and convenience for those who want more freedom in choosing their healthcare providers. It’s a strong option if you prefer provider choice or anticipate needing care while traveling.
$2,000/$4,000
Preventive
Covered at 100%
Tier 1 (Retail/Mail Order)
$5 / $10
Tier 2 (Retail/Mail Order)
$45 / $90
Tier 3 (Retail/Mail Order)
$60 / $120
Tier 4 (Retail/Mail Order)
$100 / $300
HSA
FSA
HRA
$2,500/$5,000
Annual Deductible
$5,000/$10,000
Out-of-Pocket Maximum
20% after deductible
Primary Care/Office Visit
You pay 20% after deductible
Specialist Visit
HSA-Powered High Deductible Plan.
Pair Low Premiums with a Tax-Advantaged HSA
This high-deductible health plan is paired with the option to contribute to a Health Savings Account (HSA), offering triple tax advantages.
It comes with the lowest premiums but requires you to pay more upfront before the plan begins sharing costs. It’s ideal for those who want to save for future healthcare needs, are comfortable managing costs, and want to take advantage of HSA benefits.
$2,500/$5,000
Preventive
Covered at 100%
Tier 1 (Retail/Mail Order)
$5 / $10 after deductible
Tier 2 (Retail/Mail Order)
$45 / $90 after deductible
Tier 3 (Retail/Mail Order)
$60 / $120 after deductible
Tier 4 (Retail/Mail Order)
$100 / $300 after deductible
General Documents
Click to schedule time with a Benefits Counselor!
Prescription Drug
Employees eligible for these plans:
Full-Time Employees
Prescription drug coverage helps lower the cost of medications you need. Learn what’s covered and how to get the most out of your pharmacy benefits.
General Documents
Health Savings and
Flexible Spending Accounts
Use tax-advantaged accounts to save on eligible health and dependent care expenses.
Learn the differences between HSAs and FSAs and how to make the most of your contributions.
Learn the differences between HSAs and FSAs and how to make the most of your contributions.
Employees eligible for these plans:
Full-Time Employees
Click to schedule time with a Benefits Counselor!
Health Savings Account (HSA)
Triple tax savings for health expenses now and later.
Healthcare Flexible Spending Account (HCFSA)
Stretch your dollars on everyday medical expenses.
Dependent Care Flexible Spending Account (DCFSA)
Pre-tax savings for daycare, after-school care & more.
General Documents
Advocacy Support
A Piper Jordan Advocate is ready to help you with your benefits. Learn more about this free service below.
Employees eligible for these plans:
Full-Time Employees
Part-Time Employees
Click to schedule time with a Benefits Counselor!
Benefits Support Team
A Piper Jordan Advocate is ready to help you with your benefits.
General Documents
Dental Plans
Keep your smile healthy with coverage for routine cleanings, exams, and more.
View available dental plans and what they include.
View available dental plans and what they include.
Employees eligible for these plans:
Full-Time Employees
Part-Time Employees
Click to schedule time with a Benefits Counselor!
$75 (I) / $225 (F)
Annual Deductible
$1,000/person
Calendar Year Maximum
You pay 40% after deductible
Basic Services
Orthodontic Services
Basic Care, Lowest Cost
Basic Coverage at the Lowest Cost
This plan covers preventive care in full and offers minimal coverage for additional services. It’s a good choice if you expect to need only cleanings and checkups and want the lowest bi-weekly premiums.
Part-Time Employees now Eligible for Dental Benefits!
Keep your smile shining with brand new coverage in 2026!
- You’ll enroll during Open Enrollment just like everyone else — but instead of payroll deductions, your premiums will be automatically paid bi-weekly via ACH.
- 100% of the cost is employee-paid, and premiums are after-tax.
It’s an easy way to stay covered and keep up with your dental care all year long.
$75 (I) / $225 (F)
$50 (I) / $150 (F)
Annual Deductible
$1,500/person
Calendar Year Maximum
You pay 10% after deductible
Basic Services
You pay 50% after deductible | Coverage for dependents up until age 19
Orthodontic Services
Comprehensive Protection for Dental Needs
Balanced Coverage with Orthodontic Support
With stronger coverage for basic and major services and partial orthodontic benefits, this plan balances affordability and protection. It’s ideal for families or individuals who want broader coverage without the highest premiums.
Part-Time Employees now Eligible for Dental Benefits!
Keep your smile shining with brand new coverage in 2026!
- You’ll enroll during Open Enrollment just like everyone else — but instead of payroll deductions, your premiums will be automatically paid bi-weekly via ACH.
- 100% of the cost is employee-paid, and premiums are after-tax.
It’s an easy way to stay covered and keep up with your dental care all year long.
$50 (I) / $150 (F)
$50 (I) / $150 (F)
Annual Deductible
$2,000/person
Calendar Year Maximum
You pay 10% after deductible
Basic Services
You pay 50% after deductible | Coverage for dependents up until age 19
Orthodontic Services
Comprehensive Protection for Dental Needs
Comprehensive Coverage for Full Dental Needs
This plan provides the highest annual maximum, the best cost-sharing for services, and the most orthodontic coverage. It’s best for those who expect regular dental work or have orthodontic needs.
Part-Time Employees now Eligible for Dental Benefits!
Keep your smile shining with brand new coverage in 2026!
- You’ll enroll during Open Enrollment just like everyone else — but instead of payroll deductions, your premiums will be automatically paid bi-weekly via ACH.
- 100% of the cost is employee-paid, and premiums are after-tax.
It’s an easy way to stay covered and keep up with your dental care all year long.
$50 (I) / $150 (F)
General Documents
Vision Plan
Take care of your eyesight with vision benefits that cover exams, glasses, and contact lenses.
Find providers and review plan coverage here.
Find providers and review plan coverage here.
Employees eligible for these plans:
Full-Time Employees
Part-Time Employees
Click to schedule time with a Benefits Counselor!
$5 copay
Eye Exam Copay
Lenses
Eye Plus $200 | INN $150 | OON up to $120
Frames
$0 copay up to $150 allowance
Contacts
Essential Vision at a Great Price
Essential Coverage at a Budget-Friendly Price
This plan offers great value for basic vision needs. With affordable premiums, solid coverage for eye exams, lenses, and frames, and a generous in-network allowance, it’s a smart pick for routine vision care with low out-of-pocket costs.
Part-Time Employees now Eligible for Vision Benefits!
Keep your vision sharp with brand new coverage in 2026!
- You’ll enroll during Open Enrollment just like everyone else — but instead of payroll deductions, your premiums will be automatically paid bi-weekly via ACH.
- 100% of the cost is employee-paid, and premiums are after-tax.
It’s an easy way to stay covered and keep up with your vision care all year long.
$5 copay
$0 copay
Eye Exam Copay
Lenses
Eye Plus $300 | INN $250 | OON up to $200
Frames
$0 copay up to $200 allowance
Contacts
Upgraded Benefits for Sharper Savings
Enhanced Benefits for Broader Vision Needs
This plan is ideal for those who want maximum vision benefits, including no-cost exams, lower lens copays, and a higher allowance for frames and contacts. It’s a great fit if you prioritize premium eyewear options or use both glasses and contacts regularly.
Part-Time Employees now Eligible for Vision Benefits!
Keep your vision sharp with brand new coverage in 2026!
- You’ll enroll during Open Enrollment just like everyone else — but instead of payroll deductions, your premiums will be automatically paid bi-weekly via ACH.
- 100% of the cost is employee-paid, and premiums are after-tax.
It’s an easy way to stay covered and keep up with your vision care all year long.
$0 copay
General Documents
Life & Disability
Protect your income and your loved ones with life and disability coverage.
Understand how these benefits provide financial support when you need it most.
Understand how these benefits provide financial support when you need it most.
Employees eligible for these plans:
Full-Time Employees
Click to schedule time with a Benefits Counselor!
Company-Provided Basic Life and AD&D
Core coverage your family can count on.
Company-Provided Short-Term Disability
Income protection for life's temporary detours.
General Documents
Voluntary Benefits
Enhance your protection with extra coverage like accident, critical illness, and hospital indemnity plans.
These benefits help fill coverage gaps and support peace of mind.
These benefits help fill coverage gaps and support peace of mind.
Employees eligible for these plans:
Full-Time Employees
Click to schedule time with a Benefits Counselor!
Legal Plan
BRAND NEW!
Affordable help with life’s legal moments.
Voluntary Life and AD&D
Extra protection for what matters most.
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Voluntary Long-Term Disability
Protect your income with coverage that provides financial support
Accident Plan
Get cash support when the unexpected hits.
Critical Illness Plan
A financial cushion during life’s biggest curveballs.
Pet Insurance
Peace of mind for your furry (or feathery) family.
Hospital Indemnity
Cash benefits for hospital stays and recovery.
General Documents
Employee Assistance Program
This EAP is a voluntary and confidential service to help employees and their family members who have concerns that affect their personal well-being and/or work performance.
Employees eligible for these plans:
Full-Time Employees
Part-Time Employees
Click to schedule time with a Benefits Counselor!
Employee Assistance Program (EAP)
Free, confidential support for mental health, legal, and financial guidance.
General Documents
401(k) Plan
Save for retirement with automatic 401(k) enrollment and flexible contribution options.
All your contributions are always 100% yours.
All your contributions are always 100% yours.
Employees eligible for these plans:
Full-Time Employees
Part-Time Employees
Click to schedule time with a Benefits Counselor!
401(k) Retirement Plan
Invest in your future, one paycheck at a time.
General Documents
Extra Perks
Additional perks & benefits provided at no cost to you.
Employees eligible for these plans:
Full-Time Employees
Part-Time Employees
Click to schedule time with a Benefits Counselor!
Employee Discount Program
BRAND NEW!
Perks and savings on brands you love.
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Telehealth by Teladoc
Access virtual health care in minutes 24/7 by phone, web or mobile app!
Ompractice
Access Ompractice virtual yoga and meditation at a discounted rate.
The Dinner Daily
Customized meal plans that fit your dietary restrictions
The Center for Mindfulness at UMass Memorial Health
Tuition discounts on an online mindfulness course
Amplifon
Discounts on hearing aids
Jenny Craig
Start today and receive up to $200 in food savings!
Eye360
Save on vision services & products
ChooseHealthy
Save on mindfulness and self-compassion courses
Cambridge Health Alliance
Save on mindfulness and self-compassion courses
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Fitness Reimbursement
Sometimes, it PAYS to be active
Sometimes, it PAYS to be active
Whether you like to work up a sweat at the gym or find your flow at a yoga studio, Harvard Pilgrim will reimburse you for fees you pay toward a fitness facility or other qualified membership.1 You can even use your reimbursement toward a virtual fitness class subscription.
How to get your reimbursement:
Sign up
Sign up for a participating gym, fitness facility or virtual fitness class subscription.
Be active
Be active and get fit, then submit your reimbursement!
Get reimbursed
Submit your form to get money back.
How do I qualify for fitness reimbursement?
- You must be eligible for fitness reimbursement through your Harvard Pilgrim plan. Check your eligibility.
- Your qualified fitness facility membership or fitness class subscription must be for at least four months in a calendar year
- Your current Harvard Pilgrim membership must be for at least four months in a calendar year and must coincide with four months of fitness membership or fitness class subscription
ZSonic
Discounts on dental products
General Documents
Medicare
Medicare offers different options for you to get health care coverage. Start here to get the basics and find out how Medicare works before you look at your coverage options.
Employees eligible for these plans:
Full-Time Employees
Part-Time Employees
Click to schedule time with a Benefits Counselor!
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Medicare Information
Learn the basics of Medicare and explore coverage choices so you can make informed decisions about your healthcare.
General Documents
Compliance Section
Stay informed with legally required notices and important benefit documentation.
Access all compliance materials in one convenient place.
Access all compliance materials in one convenient place.
Click to schedule time with a Benefits Counselor!
General Documents
Benefits Glossary
Stay informed with legally required notices and important benefit documentation.
Access all compliance materials in one convenient place.
Access all compliance materials in one convenient place.
Click to schedule time with a Benefits Counselor!
Beneficiary
The person(s) you choose to receive certain benefits (like life insurance or 401(k) funds) if you pass away.
Copay (Copayment)
A flat dollar amount you pay when you receive certain healthcare services, such as a doctor visit or prescription.
Deductible
The amount you pay out of pocket for healthcare before your insurance starts to share costs.
Employee Assistance Program
A free and confidential program that provides support for personal, family, and work-related issues — such as counseling, legal or financial advice, and other life resources.
Explanation of Benefits (EOB)
A statement from your insurance company showing what was paid for a healthcare service, what you may owe, and what the provider billed. An EOB is not a bill.
HSA/FSA
Tax-advantaged accounts you can use to pay for eligible healthcare expenses. HSAs are paired with high-deductible health plans and can roll over year to year.
In-Network
Healthcare providers and facilities that contract with your insurance plan — using them typically costs you less.
Out-of-Pocket Maximum
The most you’ll pay in a plan year for covered services. After you reach this limit, your plan pays 100% of covered costs.
Premium
The amount you pay (usually through payroll deductions) to have coverage under an insurance plan.
Preventive Care
Routine care — like checkups, screenings, and vaccines — designed to help you stay healthy. Covered at 100% in-network on most plans.
Qualifying Life Event (QLE)
A life change — like marriage, birth of a child, or loss of other coverage — that allows you to update your benefits outside of the annual enrollment period.
Voluntary Benefits
Optional extras you can elect (often at a group rate), like accident insurance, legal services, identity theft protection, or pet insurance.
General Documents
CarrierCorner
CarrierCorner is your hub for quick, on-demand videos and presentations from our benefit carriers. Get to know your plans and stay informed - anytime, anywhere.
Click to schedule time with a Benefits Counselor!
Videos
2026 U.S.
2026 SIMNSA (Mexico Only)
2026 HMSA (Hawaii Only)
Videos & Presentations
General Documents
General Documents
Medical
Summary of Benefits and Coverage (SBC)
TPS Group Holdings HMO HandbookTPS Group Holdings HMO HandbookAdvocacy Support
Helpful Documents
Harvard Pilgrim Member AuthorizationHarvard Pilgrim Member Authorization