Consider enrolling in a Limited Network Plan to Save Money Every Month on Your Premiums!
Limited network plans help address differences in provider costs. You will enjoy the same benefits as the wider network plans, but will save money because limited network plans have a smaller network of providers (fewer doctors and hospitals). Your savings depend on:
- The plan you are switching from,
- The plan you select,
- Your premium contribution percentage, and
- Whether you have individual or family coverage.
For example, if you pay 25% of the premium and have individual coverage, by enrolling in a limited network plan instead of a wider network plan, you will save on average $50 per month and $600 per year.
See the Active Employee Health Plan Rate page to determine what the savings would be for the plans you are considering.
Find out if your hospital is in a GIC limited network plan
Download a side-by-side comparison of the six limited network plans and their participating hospitals
For participating physician and other provider details, contact the individual plans by phone or visit their website
The GIC’s limited network plans are:
- Fallon Health Direct Care - an HMO available throughout central Massachusetts, Metro West, Middlesex County, the North Shore and the South Shore. The plan includes 28 area hospitals and another six “Peace of Mind” hospitals in Boston that provide second opinions and care for very complex cases.
- Harvard Pilgrim Primary Choice Plan - an HMO with a network of 55 hospitals. The plan is available throughout Massachusetts, except for Cape Cod, Martha’s Vineyard, Nantucket, and parts of Berkshire County.
- Health New England - a western and central Massachusetts-based HMO that includes 20 Massachusetts hospitals.
- NHP Prime (Neighborhood Health Plan) - an HMO with a provider network that includes community health centers, independent medical groups and hospital group practices, as well as 56 hospitals. NHP Prime is available across most of the state except for Berkshire, Franklin and Hampshire Counties.
- Tufts Health Plan Spirit – an EPO (HMO-type) plan with a network of 54 hospitals. The plan is available throughout Massachusetts, except for Martha’s Vineyard, Nantucket and parts of Berkshire and Hampshire Counties.
- UniCare State Indemnity Plan/Community Choice - a PPO-type plan with a network of 55 hospitals. All Massachusetts physicians participate. The plan is available throughout Massachusetts, except for Martha's Vineyard and Nantucket.
! Your Responsibility Before You Enroll in a Plan
Once you choose a plan you, cannot change health plans during the year, unless you move out of the plan’s service area. If your doctor or hospital leaves your health plan, you must find a new participating provider in your chosen plan.
- Check if your doctors participate in the plan
- Find out if the doctors’ affiliated hospitals are in the plan
- Keep in Mind: Doctors and hospitals can leave a plan during the year, usually because of health plan and provider contract issues, practice mergers, retirement or relocation.
This information provided by the Group Insurance Commission .
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