Your doctors and network

The City of Worcester Advantage plans are HMO plans, which means that in order for you to receive coverage for services, you need to see in-network providers. If you choose to see a provider who is not in your network, services will not be covered. The only exception is emergency care—with the City of Worcester Advantage plans, you are covered for worldwide emergency care, no matter where you receive it.

The Advantage plan and the Direct plan each have their own network of providers. They are designed to help you get the care you need.

The Advantage Plan and Advantage Qualified High Deductible Plan with HSA

The The Advantage Plan and Advantage Qualified High Deductible Plan with HSA have more than 60,000 providers throughout Massachusetts, southern New Hampshire and southwestern Vermont. 

Tiers

With the Advantage plan and Advantage Qualified High Deductible Plan with HSA, doctors and hospitals are "tiered," which means that they are categorized. You pay a lower copayment for office visits, inpatient hospitalizations and same-day surgeries when you use Tier 1 providers.

Tier 1: This tier includes local providers affiliated with Saint Vincent Hospital Physician Organization and Reliant Medical Group and their affiliated facilities.

Tier 2: This tier include local providers affiliated with UMass Memorial.

Tier 3: This tier includes all other providers and hospitals in the Advantage Plan and Advantage Qualified High Deductible Plan with HSA.

* This tool is currently showing tiers for FY2020. Tiers will be updated for FY2021 on July 1.

The Direct plan

The Direct plan has a high-performing and concentrated network of doctors and community-based hospitals. Because this network offers members more coordinated, cost-efficient care, your premiums, copayments and deductible may be lower than the Advantage plan.

* This tool is currently showing tiers for FY2020. Tiers will be updated for FY2021 on July 1.

Peace of Mind Program™*

When someone in your family is sick, you never feel more vulnerable. Our Peace of Mind Program™ allows Direct plan members to get a second opinion and, if they choose, receive care from a specialist at these renowned Boston medical centers.

There are some eligibility requirements for the Peace of Mind program:

  • You must be a Direct plan member.
  • You must have seen a specialist, in your network, for the same condition within the past three months.  
  • The specialty services you are seeking must be covered services (see your Member Handbook/Evidence of Coverage for a listing of services covered with your plan). Services that are not available through the Peace of Mind Program include primary care services, mental health, substance abuse, dental care, chiropractic services, obstetrics, speech therapy and infertility services. 
  • Your PCP must request a prior authorization from The City of Worcester Advantage for you to see a Peace of Mind Program specialist.

Your PCP cannot deny you the right to request access to your Peace of Mind Program benefit. If you have difficulty receiving a referral from your PCP, call The City of Worcester Advantage customer service team at
1-855-216-5924.

* The Peace of Mind Program may be used for all specialty care except infertility services, mental health, substance abuse, chiropractic services, dental care, or speech therapy. Patients may not use the Peace of Mind Program for any primary care services, including internal medicine, family practice, pediatrics or obstetrics.

Important information

Find a doctor

Advantage plan

Direct plan

* This tool is currently showing tiers for FY2020. Tiers will be updated for FY2021 on July 1.