Your benefits
- See a doctor who will help coordinate all of your healthcare
- See specialists (doctors with extra training in an area of medicine, such as cardiology, dermatology, or pediatrics)*
- Have 24/7 access to speak with a nurse about your health questions
- Get coverage for hospital treatments
- Get prescriptions covered at your local pharmacy
- Get access to behavioral health services, including crisis services and no-cost annual screenings
- Get a routine eye exam*
- Get extra help for special conditions such as asthma and diabetes
Select your plan below to see what’s covered – including your free extras. Use the Covered Services List to see what’s covered, what’s not covered, which services require prior authorization, and more.
The Member Handbooks and Covered Service Lists have been recently updated. These updates went into effect on Jan. 1, 2026 and include:
- Health-related social needs supplemental services - updates to services (ACO)
- Behavioral health - references now reflective of our in-house services
- Prior authorization – standard authorization decisions timeframe changed from 14 calendar days to 7 calendar days
- Pharmacy – Prescription Drug Monitoring Program (PDMP) name change to Controlled Substance Management Program (CSMP)
- Appeals and grievances - Continuing services during your internal appeal process - removed language that requires a member to ask for continuing services.
- Definitions - Existing definitions updated
- Children’s Behavioral Health Initiative Services (CBHI) Services
- Culturally and Linguistically Appropriate Services
- Primary Care Provider (PCP)
| Plan Name | Covered Services List | Member Handbook |
|---|---|---|
| WellSense Community Alliance |
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| WellSense Mercy Alliance |
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| WellSense Signature Alliance |
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| WellSense Southcoast Alliance |
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| East Boston Neighborhood Health WellSense Alliance |
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| WellSense BILH Performance Network ACO |
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| WellSense Boston Children’s ACO |
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| WellSense Care Alliance |
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| WellSense Essential MCO |
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*Please see the MassHealth Member Handbook and MassHealth Covered Services List for additional information, including which benefits, services and medications are covered or noncovered on our plan and any restrictions or guidelines we must follow before providing them. You can find doctors and hospitals in our network here, see our privacy policies, and learn how we make sure you get the right care at the right time with our Utilization Management policy.
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