Why was the plan created?

In January 2011, Health Plans, Inc. and Southcoast^® Health teamed up to launch the Southcoast Health Plan to employees of Southcoast Health. As a result of this new product, plan members saw no increase in employee health contributions for 2 years and Southcoast^® Health significantly reduced inpatient admission rates and emergency room visits. 

Health Plans and Southcoast Health were so pleased with the positive results that they wanted to develop a similar self-funded health plan alternative specifically designed to meet the needs of Southeastern Massachusetts employers and their employees. 

This new plan alternative, Southcoast^® Health Plan Employer Solutions, aims to improve the health and wellness of members and reduce employers’ health care expenses, while keeping health care local and affordable.

What are some plan features and highlights?

Southcoast Health Plan Employer Solutions is based on a 3-Tier design that encourages members to seek care from Southcoast^® Health hospitals and the Southcoast Physician Network. These providers are the Southcoast Health Plan Employer Solutions Tier 1 providers. The plan also offers local access to the expansive Harvard Pilgrim Health Care network and national access to the First Health and Private Health Care Systems networks.

Employer Solutions also offers a high-performing limited network plan with two network levels. 

Under the plan, members have access to an extensive list of excellent providers at varying benefit levels, giving them the freedom to choose where they receive their care and control their out-of-pocket expenses. Employers benefit from preferred Southcoast Health pricing and reduced administrative costs that come from being self-funded.

Are members required to obtain referrals to specialists?

Members select a PCP, but PCP referrals to specialists are not required. Southcoast Health Plan Employer Solutions members also have the advantage of accessing the Patient Service Center— a dedicated phone service that helps members choose a Tier 1, Preferred PCP. Southcoast Care Connect also helps members schedule appointments.