Several of your 2024 plan benefits offer a reimbursement for qualified items and services. You pay out-of-pocket for these services, then your plan reimburses you. 

• Weight Management: $150 per calendar year¹
• Wellness Allowance: $150 per calendar year ($350 per calendar year for Saver Rx, Smart Saver Rx, and Access PPO members)² 
• Eyewear Benefit: $150 per calendar year in the EyeMed network, or $90 per calendar year out-of-network (Access PPO members get up to $150 with no EyeMed participating provider requirement). Only out-of-network services need to be paid out-of-pocket and submitted for reimbursement. 

How can you request a reimbursement? 

Each benefit has its own reimbursement request form with instructions for submitting. Forms can be found at thpmp.org/forms. Requests for 2024 must include proof of payment in the form of paid, itemized receipts and be submitted no later than March 31, 2025. Proof of payment must be in the member’s name or, alternatively, in the name of the member’s representative on record. 

How long does it take to receive a reimbursement? 

Once received, your reimbursement request(s) will be processed within: 

• 60 calendar days for Weight Management and Wellness Allowance reimbursements 
• Up to 30 days for out-of-network Eyewear Benefit reimbursements 

How can you request a reimbursement for something else? 

If you need to request a reimbursement for another purpose, such as a prescription or a dental service, you can find additional requests forms at thpmp.org/forms:

• Part D Prescription Reimbursement Form—Submit along with the original pharmacy receipt. Reimbursements take up to 14 days to be processed.
• HMO Dental Claim Form—Submit along with proof of services and proof of payment. Reimbursements take up to 30 days to be processed.

What 2024 expenses are reimbursable?

• Weight Management—Program fees for weight loss programs such as Weight Watchers, or hospital-based weight loss programs.¹
• Wellness Allowance—Costs of qualified fitness, nutritional, or wellness programs. Examples include gym memberships, in-person and online fitness classes, nutritional counseling, chronic disease self-management programs, diabetes workshops, licensed acupuncture visits, and more.
• Eyewear Benefit—HMO members get up to $150 toward the full retail price of a pair of prescription eyeglasses and/or contact lenses from any provider in the EyeMed network. The discount will be applied at the time of service and a reimbursement request is not required. If you use an out-of-network provider, you are covered for up to $90, and you pay out of pocket and submit for a reimbursement. 

Access PPO members get up to $150 toward the full retail price of a pair of prescription eyeglasses and/or contact lenses. The discount will be applied at the time of service if you use a provider in the EyeMed network. If you use a provider outside of the EyeMed network, you pay out of pocket and submit for a reimbursement.

Discounts cannot be combined.

For a complete list of covered services, see your Evidence of Coverage, available at thpmp.org/documents.

Benefit information described is for Tufts Health Plan Medicare Advantage HMO and Access PPO plan members. Benefit information may be different if you receive your benefits from a current or former employer.

¹$150 is the total reimbursement amount each year (Jan. 1–Dec. 31). This benefit does not cover costs for pre-packaged meals/foods, books, videos, scales, or other items or supplies.

²$150 (or $350 for members of our Smart Saver, Saver Rx, and Access PPO plans) is the total reimbursement amount each year (Jan. 1–Dec. 31) whether used for health clubs, fitness classes, nutritional counseling, or wellness programs.