Boston Medical Center HealthNet Plan

Boston Medical Center (BMC) HealthNet Plan is a 501(c)(3) status managed care organization providing coverage to MassHealth (Medicaid) and Commonwealth Care members. Founded in 1997 by Boston Medical Center, the Plan contracts with providers and hospital systems throughout Massachusetts to deliver care to over 200,000 members.

The mission of BMC HealthNet Plan is to be a quality and cost effective provider-sponsored managed care organization supplying excellent care coordination and services.

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Provider Oriented

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 our members – and provider network – BMC HealthNet Plan has offices in Boston (our main office), as well as in New Bedford Springfield and Pittsfield. Our goal is to ensure local support in all regions where we provide coverage.

Coordinated Care

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 or congestive heart failure. Members also can benefit from the Plan’s behavioral health care management services.

Service Area and Network for BMC HealthNet Plan MassHealth

The HealthNet service area includes more than 200 Massachusetts cities and towns in 25 of 38 service areas defined by MassHealth. We contract with primary and specialty care physicians at more than 300 locations, as well as 30 hospitals and 1,000 pharmacies.

Statewide Service Area for BMC HealthNet Plan Commonwealth Care

BMC HealthNet Plan is the only managed care organization approved to provide coverage for Commonwealth Care members in all areas of Massachusetts. Our provider network for Commonwealth Care includes the providers in our MassHealth network, plus we are continually contracting with primary and specialty care providers, as well as hospitals, in our new Commonwealth Care service areas in the Merrimack Valley, the North Shore and Worcester/Central Massachusetts.

About Commonwealth Care

Passed by the General Court on April 4, 2006, and signed into law by Governor Mitt Romney on April 12, 2006, the [[Massachusetts_health_care_reform|Massachusetts Health Care Reform] extends access to health insurance to a larger population of uninsured adult Massachusetts residents through the creation of the Commonwealth Care Health Insurance Program.
BMC HealthNet Plan, and their parent organization, Boston Medical Center, worked alongside legislators and state officials in initially crafting this first-in-the-nation program. The Plan, which has been providing insurance coverage since 1997, is offering Commonwealth Care coverage as a second coverage option to its successful MassHealth product. With Commonwealth Care, the Plan is widening the healthcare safety net for those Massachusetts residents who have not previously been eligible for MassHealth.
The Plan works closely with the Commonwealth Care Health Insurance Connector (referred to as the Connector), which is the governing board empowered to make key decisions, approve insurance products, and set affordability standards. The Connector meets regularly with the Plan and the three other managed care organizations (MCOs) to ensure that the standard packages of benefits are of high quality. These meetings are open to the public. When new details about the program, the enrollment process, and potential changes to the benefit packages become known, BMC HealthNet Plan will keep providers up-to-date through mailings, newsletters, and in postings on this Web site.
Commonwealth Care Health Insurance provides health care for the whole person: mind, body and spirit. It covers doctors’ visits, hospital stays, specialty care, prescriptions, mental health, dental and vision services, and more. It is available at provider offices throughout eastern, western, and southeastern Massachusetts.
The State estimates that more than 200,000 individuals will be eligible for Commonwealth Care. During the next three years, BMC HealthNet Plan and other MCOs will exclusively offer Commonwealth Care Plans to low income individuals. Eligibility determination via the virtual gateway commenced October 1, 2006, with the earliest effective date of November 1, 2006.