Qualified Health Plans

To choose one of our Qualified Health Plans, you must live in the service area for that plan

Your choice of doctors and hospitals depends on where you live and the plan you pick.

What do our Qualified Health Plans cover*?

When you select WellSense, you get access to our provider network and coverage for:

  • Doctor visits for preventive care
  • Specialist visits
  • Treatment at hospitals
  • Prescriptions
  • ER visits when you have an emergency
  • Care before and after your baby is born
  • Well-care visits for your child
  • Extra help for special conditions such as asthma and diabetes
  • Mental health and substance-use services

Our Great Member Extras

Our members can get and stay healthy by taking advantage of Member Extras including:

  • Money back for participating in WW® (formerly Weight Watchers®)
  • Partial reimbursement for either gym membership fees or a fitness tracker purchase
  • Discounts on eyeglasses

To learn more about what medical services are covered, view your plan documents.

Marketplace Rate Increase Justification

Rate increases are sometimes necessary for health plans sold on a health insurance marketplace. The rate increase justifications for WellSense marketplace plans can be found on ratereview.healthcare.gov by selecting Massachusetts, WellSense, and searching the desired date range.

*Please see the current year's Qualified Health Plan Evidence of Coverage and Schedule of Benefits for specific information on each plan, or additional information including which benefits, services and medications are covered or non-covered 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 practices, and learn how we make sure you get the right care at the right time with our Utilization Management policy.