Who we are
Boston Medical Center Health Plan, Inc. is a not-for-profit managed care organization. Known in Massachusetts as Boston Medical Center (BMC) HealthNet Plan, we serve more than 260,000 members across the state. Founded in 1997 by Boston Medical Center, BMC HealthNet Plan’s 400 employees work in the Boston headquarters or in regional offices in Springfield and New Bedford. The health plan currently serves members across three product lines: MassHealth (Medicaid), Commonwealth Care, and commercial (Commonwealth Choice/Employer Choice).
Additionally, Boston Medical Center Health Plan, Inc. was selected by the New Hampshire Department of Health and Human Services as one of three managed care organizations to offer coverage to that state’s 115,000 Medicaid managed care program recipients, beginning in 2013. In New Hampshire, we operate as Well Sense Health Plan. For information, please go to wellsense.org.
Recognized for Quality
BMC HealthNet Plan was recognized for its ongoing commitment to quality when it was named one of the top 10 Medicaid health plans in the country according to the National Committee for Quality Assurance (NCQA) Medicaid Health Insurance Plan Rankings 2012-2013. In additional, it has maintained Excellent Accreditation from NCQA for its Massachusetts Medicaid plan since its initial accreditation in 2009.
Coordinated, Exceptional Care
To serve its MassHealth and Commonwealth Care members, BMC HealthNet Plan contracts with nearly 60 hospitals, 15,000 health care providers, and 1,200 pharmacies across the state (except for Martha’s Vineyard and Nantucket). For its Commonwealth Choice/Employer Choice plans, BMC HealthNet Plan currently offers a network of selected healthcare providers in eastern Massachusetts.
Each BMC HealthNet Plan member chooses a personal primary care provider (PCP) who delivers or arranges for the member’s care. The Plan also offers special care management programs for members who are pregnant or who have asthma, diabetes, or other medical conditions.
Our Programs and Health Insurance Products
Since 1997, BMC HealthNet Plan has offered high-quality, affordable health insurance coverage through its MassHealth product to low-to-moderate-income individuals in Massachusetts qualifying for fully subsidized health care coverage through the state’s MassHealth (Medicaid) program. BMC HealthNet Plan is the largest MassHealth health plan in Massachusetts with 190,000 MassHealth members.
In 2006, BMC HealthNet Plan began participating in the state’s Commonwealth Care program, which makes subsidized, comprehensive, affordable health insurance coverage available to eligible Massachusetts residents. BMC HealthNet Plan offers the lowest premium price in the Commonwealth Care program.
Beginning in 2011, the Plan began enrolling individuals and their families and small businesses in its Commonwealth Choice/Employer Choice commercial products.
In 2012, BMC HealthNet Plan was selected by the Massachusetts Executive Office of Health and Human Services for contract negotiations to participate in the Massachusetts Medicare-Medicaid Demonstration. BMC HealthNet Plan will now advance to a joint state and federal readiness review process to prepare to serve as an Integrated Care Organization to manage the health care for adults, ages 21-64, who qualify for both Medicaid and Medicare. The dual eligible population covered by this Demonstration is diverse in terms of its health needs with some individuals having extremely complex medical and behavioral health issues. The program is expected to start in 2013.
Also in 2012, BMC HealthNet Plan was selected by New Hampshire's (NH) Department of Health and Human Services as one of three health plans to manage care for NH Medicaid members. The program is slated to start in 2013.
In addition to coverage for doctor visits, hospital care, and prescription drugs, BMC HealthNet Plan is committed to helping members get and stay healthy by offering Healthy Extras. These include car seats, kids’ bike helmets, dental kits, Weight Watchers® reimbursements and fitness reimbursements for MassHealth members, Weight Watchers reimbursements, fitness reimbursements and dental kits for Commonwealth Care members, and Weight Watchers and fitness reimbursements for Commonwealth Choice/Employer Choice members. The Plan also maintains an online Wellness Center to provide members with wellness tips and tools, as well as links to other healthy resources.
Working in and Committed to Our Communities
Headquartered in Boston with offices in New Bedford and Springfield, Massachusetts, and also in Manchester, New Hampshire (Well Sense Health Plan), the Plan knows and is committed to supporting the communities it serves. Through its community outreach team, the Plan partners with its healthcare providers and local organizations to educate Massachusetts residents about health and wellness topics, as well as their affordable healthcare coverage options.
Outstanding Customer Service
Members have access to BMC HealthNet Plan’s customer service representatives for questions about their benefits and how to get the most out of their coverage. Interpreters are available to assist them in any language, and the Plan employs TTY numbers for members with hearing loss. BMC HealthNet Plan also offers members a 24/7 Nurse Advice phone line for medical concerns and a 24/7 behavioral health phone line for mental health and substance abuse concerns.
Members also can use the Plan’s online self-service website portal – 24/7 – to electronically submit address changes and PCP requests, order ID cards or to look up claims history.