How services are covered Here is a partial list of covered services under a typical Best Buy HMO plan. An example of how you’dpay for them follows on the next page. Refer to the Schedule of Benefits for a complete list of benefits.

The Harvard Pilgrim Best Buy HMO offers Harvard Pilgrim’s high-quality coverage and extensive network of doctors at a more affordable premium than a traditional HMO.

> You’ll choose a primary care physician—from among thousands that accept Harvard Pilgrim—to provide or coordinate your care.

> For some services you will pay a copayment. > For other services you must first satisfy a deductible.> Certain tests and screenings are covered at no charge.> When you travel and need unforeseen care, your coverage travels with you.

Best Buy

HMOHOW IT WORKS:

The Harvard Pilgrim Best BuyHMO - Massachusetts

• Routine physical exams*

• Routine eye exams

• Consultations with PCPsand specialists

• Annual GYN exams andfamily planningconsultations

• Mammograms

• Pap smears

• Immunizations

• Prostate screenings

• Total cholesterol

• Routinehemoglobin tests

• Inpatient acute hospitalservices and day surgery

• Hospital outpatientdepartment services

• Certain diagnostic procedures, such as X-rays and lab tests

• Treatments andprocedures, such as

chemotherapy, surgicalprocedures and allergy

treatments

Subject to deductible, then

no charge

Subject to copayment

No charge

Continued on next page >

* Some services you receive during a routine physical exam may be subject to the deductible.

Please note: Emergency room services are subject to the deductible; once met, an emergency room copayment applies.

You visit the doctor’s office for a routine physical exam,

and your doctor performs an X-ray.

• Routine physical exams are subject to an officevisit copayment. Your copayment does notapply toward your deductible amount.

• X-rays are subject to the deductible. If youhave not yet paid the full, annual deductible,you pay all charges for the X-ray up to thedeductible amount. If you have already paidthe full, annual deductible amount, you paynothing for the X-ray.

In summary, you would be responsible for the copayment for the exam, plus charges forthe X-ray if you had not yet met your totaldeductible.

Your primary care physician’s role

Your primary care physician (PCP) will provideor arrange for the health services you need—treating you when you’re sick and providingroutine check-ups, preventive screenings andimmunizations. If you need care from a special-ist, your PCP will need to give you a referral formost specialist services.

As a plan member, you must choose a PCPwhen you enroll. If you do not have a PCP,non-emergency and most specialty services may not be covered.

Finding a primary care physician is easy

Thousands of doctors participate in the HarvardPilgrim provider network—so it’s easy for youto get the care you need. To find a PCP:

• use our online directory (updated weekly) atwww.harvardpilgrim.org

• call one of our representatives (See“Questions?” at the end of this document for phone numbers.)

• use our printed Provider Directory (Youremployer may have a copy, or you can callHarvard Pilgrim to request one.)

If you will be covering dependents on your policy, you can each have a different PCP. Pleasewrite the doctors’ names and provider ID codesin the designated spaces on your enrollment form. If your employer uses HPHConnect,Harvard Pilgrim’s Web-based transaction service, you may be able to enroll online at www.harvardpilgrim.org.

Once you’re a member, you can choose a different Harvard Pilgrim PCP for any reason.Just call Member Services or use HPHConnectto change doctors.

COPAYMENT: A dollar amountyou pay for certain coveredservices. The copayment is dueat the time of your visit orwhen the provider bills you.Copayments are always fixeddollar amounts.

DEDUCTIBLE: A dollar amountyou must pay each calendaryear before certain services arecovered under your healthplan. This means you may berequired to pay all or part of abill, up to your full, annualdeductible amount.

See the Schedule of Benefitsfor more detailed informationon copayments and deductiblesand the services to which they apply.

GLOSSARY

EXAMPLE:

Facts about referrals

If you need specialty care, your PCP will referyou to another physician or appropriate medicalprofessional. (Referrals are not necessary forsome services, such as routine vision exams orcertain gynecological exams.) While there are

thousands of physicians who takecare of Harvard Pilgrim mem-bers, your PCP will send you to aspecialist affiliated with his or herown practice. If you need to visita cardiologist, for example, yourPCP will refer you to someone in a local medical practice orhospital with which he or she is affiliated.

PCPs typically develop strong working relation-ships with particular specialists. This helps thedoctors collaborate more effectively on theirpatients’ care and helps ensure excellent communication, appropriate treatment andhigher-quality care.

Whenever you need specialty care, feel free toask your PCP about the referral process and why he or she recommends a certain specialist.Your PCP may occasionally make a referral to aphysician outside his or her usual network ofspecialists, but only if the expertise needed tohandle a particular case is not available from aspecialist affiliated with his or her own practice.

You’re covered when you’re traveling . . .

When you’re away, you’re covered for care youmay need if you become sick or injured.Harvard Pilgrim covers unexpected or unfore-seen care (e.g., for earaches, flu, etc.) whenyou’re traveling outside the state in which you live.

And in an emergency

Harvard Pilgrim covers all medical emergencies(e.g., heart attack, stroke, choking, loss of con-sciousness or seizures). Just go to the nearestemergency facility or call 911 or another localemergency number.

With the Best Buy HMO, emergency services are subject to the deductible. Once you meet the deductible, an emergency room copaymentapplies. This copayment is waived if you areadmitted directly to the hospital from the emergency room.

If you are hospitalized, you must call your PCPwithin 48 hours, or as soon as you can (or asksomeone to do this for you). If your attendingphysician notifies your PCP, this requirementwill be met. Your PCP will arrange for any fol-low-up care you may need.

Questions?

If you’re already a member, call MemberServices with questions at (888) 333-4742.For TTY service, call (800) 637-8257.Representatives are available weekdays from 8:00 a.m. – 5:30 p.m., and until 7:30 p.m. on Monday and Wednesday.

If you’re not yet a member, call (800) 848-9995 on weekdays from 8:30 a.m. – 5:00 p.m.

To learn more about us in general, visit www.harvardpilgrim.org.

Stay healthy and save moneyEnjoy fitness, nutrition and eyewear dis-counts through the Your Member Savingsprogram. Visit www.harvardpilgrim.org/savings for a complete list of programofferings and details.

cc1686_bb_hmo_ma 11_08

93 Worcester Street, Wellesley, MA 02481

(800) 848-9995

www.harvardpilgrim.org