What We Do

Overview of BMC HealthNet Plan

Boston Medical Center (BMC) HealthNet Plan is a health maintenance organization located in Massachusetts. Founded in 1997 by Boston Medical Center, the Plan manages healthcare coverage for Massachusetts residents participating in MassHealth (Medicaid), and Commonwealth Care — subsidized health insurance programs for low-income individuals, as well as a commercial product. The Plan contracts healthcare providers throughout the state to deliver care to nearly 240,000 members.

Partnering with healthcare providers

BMC HealthNet Plan views its participating providers as partners in a commitment to clinical excellence for low-income individuals and families who are the providers’ patients and the Plan’s members. The Plan’s care-related policies are provider-driven. For example, the Plan requires no pre-authorizations for office visits to participating specialists.

In addition, to better serve its members and provider network, BMC HealthNet Plan has offices in Boston (main office), as well as in New Bedford and Springfield. The goal of having regional offices is to ensure local support in all regions of Massachusetts where the Plan provides coverage.

Coordinated care coverage

Each BMC HealthNet Plan member selects a personal physician who provides or arranges for the member’s care. All approved physician services, inpatient admissions, and outpatient visits are covered. The Plan also offers special care management programs for members who are pregnant or who have asthma, diabetes, HIV/AIDS, or congestive heart failure. In addition, members can benefit from the Plan’s behavioral health care management services. The Plan focuses on bringing together medical and behavioral health providers to deliver care to the whole person: body and mind. BMC HealthNet Plan seeks to help members and the community-at-large get and stay healthy through a variety of wellness programs, such as those described on this Web site.