Understanding your benefits

Benefits are the healthcare items or services covered under your health insurance plan. On this page you’ll find information about some of the benefits and perks included in Mass General Brigham Health Plan plans.

Benefits vary by plan, so not all the benefits listed here are applicable to all members. It’s important to check your plan documents to understand which benefits are covered under your plan.

If you’re currently a Mass General Brigham Health Plan member, you can find your specific plan details on the Schedule of Benefits, a document with detailed information about what your plan covers and your member cost sharing. You can find this document on the Mass General Brigham Health Plan Member portal or Mobile app under Plan documents

My Care Family members can learn about the benefits available as part of your plan on our My Care Family page.
 

Preventive services

Preventive services are covered by your plan for $0 cost sharing. You can get help understanding the different types of cost sharing and the differences between preventive and diagnostic care with this helpful video.
 
Preventive prescription drugs are also covered for $0 cost sharing if your plan includes prescription drug coverage through Mass General Brigham Health Plan.
 
View the list of:  

Help for common and complex healthcare needs

Our comprehensive coverage includes programs to help manage or treat your common and complex health care needs. Please refer to your Schedule of Benefits to see if the benefits below are included in your plan.
  • Asthma management program
    Our asthma program helps you better manage your asthma by making sure you get the care you need. A certified Respiratory Therapist will work with you and your health care provider to come up with a treatment plan that works for you.
  • Cardiac care management

    The cardiac care management program is designed to help members living with or at risk for congestive heart failure, heart failure, coronary artery disease, or high blood pressure (hypertension). You'll get disease-specific education by a Cardiac RN who can help coordinate your care.

  • Disease management programs

    Our specialized disease management programs provide comprehensive support, education, and outcomes measurement for several conditions and diseases that frequently affect our members like arthritis, cancer, Crohn’s disease, cystic fibrosis, fibromyalgia, injuries, kidney disease, lupus, or multiple sclerosis.
     
    Members with these conditions are identified and offered the opportunity to voluntarily participate in unique programming to meet the needs of individuals living with these conditions. Mass General Brigham Health Plan clinicians with expertise in these programs work to develop tools and materials to help Members achieve improved health status and quality of life.

  • Chronic obstructive pulmonary disease (COPD) program

    There are many forms of lung conditions that are defined as COPD that affect members. If you have one of these conditions, you may benefit from the extra care and education that our COPD care management program provides. COPD care managers work with network providers and reach out to members considered to be at-risk for respiratory-related complications by providing education and support.

  • Diabetes

    The diabetes care management program provides members living with or at risk for type 1 or 2 diabetes support from a Certified Diabetes Educator.

  • Family & children

    Pediatric care savings. This parent/wallet-friendly benefit covers the first 3 sick primary care provider visits and 3 behavioral health visits for members age 18 and younger at no member cost sharing, per benefit period.
     
    Maternal & child health care management. This program offers a wide range of services to help provide access to great care throughout pregnancy, after childbirth, and at every stage of childhood.
     
    Childbirth education reimbursement. If the facility where you plan to deliver does not offer a childbirth education program, Mass General Brigham Health Plan will reimburse you for the full the cost of these classes up to $130 per pregnancy.
     
    Breastfeeding support reimbursement. If the facility where you plan to deliver does not offer breastfeeding support classes, Mass General Brigham Health Plan will reimburse you for the full cost of these classes.

  • Fitness & weight loss

    Healthier YouSM program. Healthier You is a year-long program for our members who are looking to lose weight, become more active, and reduce the risk of conditions such as diabetes and heart disease. Download the Healthier You flyer.
     
    Fitness and weight-loss reimbursements. Many Mass General Brigham Health Plan plans include fitness and weight-loss benefits that reimburse members for subscriptions, programs, or activities at qualifying fitness facilities, and up to six months of membership fees at a qualified weight-loss program.

  • Health coaching

    For help achieving your wellness goals, like eating healthier, getting more sleep, and de-stressing after work, our health coaches are here to help.

    Learn more about talking with a health coach.

  • Mental health & substance use

    Mental health is a key part of your overall well-being, and we're here to help you get the support you need to manage your mental health care.
     
    Find more mental health resources
     
    Substance use
    Our on-staff recovery coaches are available for members who are recovering from addiction. Coaches have personal experience with substance use disorder and can guide and support members before, during, after, and instead of treatment.

  • Prescription drugs & medications

    For plans that include prescription drug coverage through Mass General Brigham Health Plan, our FlexRxSM pharmacy program helps you save on certain prescriptions and makes it easy to get your medications by mail or in person.

    See what’s covered

  • Tobacco cessation

    For members looking to quit tobacco we offer telephonic counseling with a Certified Tobacco Treatment Specialist (CTTS).

    Learn how to start a quit plan with the Quit for Life program.
     

    Get help to quit – a free tobacco cessation resource
    Visit MakeSmokingHistory.org or call 1-800-QUIT-NOW to get help to quit smoking, vaping, or other tobacco products through approved medicine and free counseling from the Massachusetts Department of Public Health. Enroll online to get 8 weeks of free nicotine patches and help to quit.

 

Benefits and programs designed with you in mind

Mass General Brigham Health Plan members get access to world-class benefits and programs that help you save money on the care you need.

  • Care Complement - Removing the cost barriers to care options

    Built on the understanding that there’s more than one way to solve a problem, Care Complement gives members the flexibility to try alternatives to opioid painkillers and new treatments for managing chronic conditions.
     
    Care Complement benefits offer $0 cost for services that help members manage pain and other chronic conditions. Some of the services covered under this benefit include:

    • Your first 6 visits to a chiropractor, acupuncturist (20 visit limit), and physical or occupational therapist
    • Services to help you manage your diabetes
    • Medication-assisted therapy office visits and prescriptions to treat substance use
    • 11 common prescription medications to treat depression, heart conditions, and high blood pressure
  • DoctorSmart RewardsSM - Cash back for making smart choices about care
    Save money — and earn rewards of up to $500 — with the DoctorSmart Rewards program. Different providers may charge very different prices for the same procedure, even when they’re delivering the same level of care. DoctorSmart Rewards makes it easy to find these high-value providers, so you can save on out-of-pocket costs. DoctorSmart Rewards also gives members a cash incentive for making smart choices about where to get select services like CT scan, mammogram, MRI, and more.
  • DSC2U - Down Syndrome Clinic 2 You
    Members with Down syndrome and their caregivers get no-cost access to a virtual platform that provides personalized care plans. The brainchild of researchers and clinicians at Massachusetts General Hospital, the virtual clinic at DSC2U.org aims to improve the health care journey for patients with Down syndrome and make sure they get the right kind of care, at the right time.
  • On Demand - Virtual urgent care

    On Demand offers convenient, high-quality virtual urgent care services for minor illnesses and injuries—and it’s available anytime and anywhere in the United States. Members (adults and children age 3 and older) connect to providers through a secure, interactive video visit on the web or mobile device.
     
    On Demand is not for medical emergencies. For medical emergencies, call 911.

  • Path to Lifestyle Change - Diabetes risk management
    Path to Lifestyle Change is a lifestyle intervention program that helps eligible members make changes to promote weight loss and healthier living, which can delay or prevent the onset of type 2 diabetes. Led by an expert team of lifestyle interventionists and dietitians from Mass General Diabetes Center, participants learn about nutrition, physical activity, and behavioral strategies and receive the education, tools, and support they need to make lasting lifestyle changes. Members access group sessions by phone.
     

Need help? Contact our Customer Service team

If you have questions or need help with any of the resources on this page, we are here to help. Please call us at 866-414-5533, or at the number on the back of your member ID card.
 
You can also email us at healthplanCustomerService-Members@mgb.org or go to Member.MassGeneralBrighamHealthPlan.org to start a live chat with a Customer Service Professional. We are available Monday through Friday, 8:00 AM to 6:00 PM and 8:00 AM to 8:00 PM on Thursdays.