You will receive your ID card and Welcome Kit in the mail. Remember to bring your ID card to all of your doctors' appointments and whenever you pick up prescriptions.

• Doctor visits for your routine healthcare
• Visits with specialists (doctors who have extra training in an area of medicine)
• Emergency room visits
• Screenings for diabetes, allergies, heart disease, etc.
• Extra help for special conditions like asthma and diabetes
• Mental health and substance abuse services
• Prescriptions
• Money back for participating in Weight Watchers® or a qualifying health club
  
  

*There are some restrictions and certain services or doctor's visits will need prior written approval before they will be covered. For additional information see the links below.

In an Emergency (inside or outside the Service Area), you should call 911 or seek care at the nearest Emergency facility. If 911 services are not available in your area, call the local number for Emergency Medical Services.

You need to choose a doctor for all your routine care. Your doctor, also called a Primary Care Physician or PCP, should be the first person you call when you have medical issues (unless it is an emergency). Your doctor will help manage your health and send you to specialty doctors or hospitals when needed. If you do not choose a doctor, one will be assigned to you—but you can change at any time.

There may be times when you may need to see a Specialist. A Specialist is a healthcare provider who is trained to offer specific, often more detailed, treatments than your PCP. If you think you need to see a Specialist, you should first call your PCP. Your PCP can help you identify your specialty care needs.

Generally, any doctor or hospital that you visit must be chosen from a list of providers who work with BMC HealthNet Plan and accept your plan type. They are also called “in-network” providers. Your doctor will refer to you other doctors or hospitals on our approved list to make sure that your medical visit is covered by insurance (there are some exceptions). See a list of doctors and hospitals you can use.

For a complete list of the services covered by BMC HealthNet Plan, read the Covered/Excluded Services List. This is the most important document you have, since it tells you what BMC HealthNet Plan will or will not cover. Your Covered/Excluded Services List should have come in the mail, or you can find your plan's list here.

In general, you must get all your healthcare services from BMC HealthNet Plan network doctors and providers. The only four exceptions are:

• If you need emergency care (or treatment at the closest emergency room for serious illness or injury in a life-threatening situation)
• If you need urgent care when you are traveling outside our service area
• If you need family planning services
• If BMC HealthNet Plan (or Beacon Health Strategies for behavioral health services) gives prior approval, also called prior authorization, for you to get care from an out-of-network provider

We partner with Beacon Health Options to manage Behavioral Health services. Call Beacon for help finding a provider for Behavioral Health services. You can also access their online provider directory here.

• MassHealth members: 888-217-3501 toll-free, 24-hour Behavioral Health telephone line
• ConnectorCare/Qualified Health Plan members: 877-957-5600 toll-free, 24-hour Behavioral Health telephone line
• beaconhealthoptions.com

Some services and medications need prior approval, or prior authorization, from BMC HealthNet Plan before they will be covered. Your PCP will get this approval for you, which is why it is important that you choose a doctor that you are comfortable with who can get to know your health care needs.

If you or your PCP did not receive prior approval, BMC HealthNet Plan will not pay your doctor for your care or services. Your doctor may hold you responsible for the costs of your treatment.

Yes. Call the Nurse Advice Line at 800-973-6273 (MassHealth) or 866-763-4695 (ConnectorCare/Qualified Health Plan) and speak to a registered nurse when your doctor's office is closed or if you have a question about your health. All calls are confidential and you can call anytime, seven days a week.

Our free Care Management Program can make living with conditions like asthma, diabetes, cancer, or other special health needs easier. Pregnant members can get help through this program too. Call 866-853-5241 to see if you or your family members qualify.

Like services, some drugs require approval before they will be covered. For a list of drugs covered by BMC HealthNet Plan, search our drug list.

An ACO is made up of doctors, hospitals, and other healthcare providers who work closely together to care for patients. Your health history and information are shared between your doctors, so your visits will be more personalized and efficient. Your doctors will be better prepared to help you stay healthy and out of the emergency room.

In an ACO, doctors work closely together and share information about their patients. This means your doctor will have the full picture of your health and will be able to make sure you get the care you need, when you need it. But an ACO can also help you outside of the doctor’s office with benefits like access to community resources, support groups, and classes. These extra resources are there to help keep you healthy.

You can find out if your plan type is part of an ACO by checking your health insurance ID card. You can also contact our Members Services department for more information.

We are committed to improving your health and health care. BMC HealthNet Plan has made it easier for you to access your personal health information which can help you make more informed decisions about your health care. Click here for more information on how to access your health information online.

Remember, you can call Member Services, Monday-Friday 8:00 a.m.- 6:00 p.m. for help with any of the items above and much more.

MassHealth members:

• 888-566-0010 (English and other languages)
• 888-566-0012 (Spanish)
• 711 (TTY)

My Ombudsman is a program for MassHealth members who have questions or need help getting services from their health plan. The program can:

• Give members information about their health plan benefits and rights,
• Answer questions, listen to members concerns and help address problems, and
• Explain how to file a grievance or appeal and what to expect during the process

For more info on My Ombudsman:

• Visit www.myombudsman.org 
• Email info@myombudsman.org
• Call (855) 781-9898, videophone (VP) (339) 224-6831, Monday-Friday, 9 a.m.- 4 p.m.
• Visit 11 Dartmouth Street, Suite 301, Malden, MA 02148, Mondays 1 p.m.-4 p.m., Thursdays 9 a.m.-12 p.m.

ConnectorCare / Qualified Health Plan members:

• 855-833-8120 (English and other languages)
• 711 (TTY)