Harvard Pilgrim’s Enrollment Area for HMO Plans is Changing

Posted 08.25.23

Harvard Pilgrim will stop doing business in Connecticut on December 31, 2023. As a result, the enrollment area for their HMO plans is changing. Harvard will be notifying clients based in Massachusetts, New Hampshire, and Maine with members residing in CT. Members will be notified of next steps based on their current residence:

  • Members living in a CT zipcode outside of the 2024 enrollment area will no longer be eligible to enroll in the HMO plan.  They will need to move to a PPO or POS plan effective January 1, 2024.
  • Members living in a town contiguous to the 2024 enrollment area will still be eligible for the HMO but with a significantly reduced network access.  The member must choose whether to stay in the HMO with limited access or move to the PPO/POS plan.

In both cases, this change in plan eligibility or network access is considered a qualifying event. For those members living in a contiguous town where the local network will be changing significantly, members should carefully consider the impact to their care as most providers will be out-of-network for the HMO. To ensure coverage at the in-network level, members should consider changing to an alternate plan effective January 1, 2024.

The letter sent to affected members will advise them to speak with their employer’s benefits contact about any resulting changes to their contribution. Harvard will work with clients to make any enrollment changes for these members later in 2023.

While most Connecticut providers are available for medical services at the in-network benefit level through Harvard’s relationship with UnitedHealthcare, members are advised to check whether their current providers are part of these networks to insure in-network coverage starting January 1, 2024.  The provider directory will be updated in early October to reflect these changes. In the unlikely event that their providers are not part of our PPO or POS provider networks, members can still receive care from them but may need to pay more out of pocket for out-of-network coverage.



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