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  • Summary of Benefits and Coverage

    As required by federal health care reform, this document provides a summary of a GIC plan’s benefits and cost-sharing requirements.  View and print all GIC SBCs.
  • Prescription Drug Benefits - All GIC Health Plans

    All GIC health plans provide benefits for prescription drugs using a three-tier co-payment structure in which your co-payments vary depending on the particular drug dispensed.
  • Mental Health Benefits UniCare Plans, Tufts Navigator and Tufts Spirit

    Mental Health and Substance Abuse Benefits for Tufts Health Plan Navigator, Tufts Health Plan Spirit and the UniCare State Indemnity Plans (Basic, Community Choice, PLUS, and Medicare Extension) are provided by Beacon Health Strategies.
  • Calendar Year Deductibles - Question & Answers

    All GIC Employee and Non-Medicare Retiree/Survivor health plans include a calendar year deductible. The in-network deductible is $250 per member to a maximum of $750 per family. This is a fixed dollar amount you must pay before your health plan begins paying benefits for you or your covered dependent(s).
  • Fallon Health Direct Care HMO

    Fallon Health Direct Care is an HMO that provides coverage through the plan’s network of doctors, hospitals and other providers.  Members must select a Primary Care Provider (PCP) to manage their care and obtain referrals to specialists.  The plan offers a selective network based in a geographically concentrated area. 

  • Fallon Health Select Care HMO

    Fallon Health Select Care is an HMO that provides coverage through the plan’s network of doctors, hospitals, and other providers.  Members must select a Primary Care Provider (PCP) to manage their care and obtain referrals to specialists. 

  • Harvard Pilgrim Independence Plan PPO

    The Harvard Pilgrim Independence Plan, administered by Harvard Pilgrim Health Care, is a PPO plan that offers coverage through network doctors, hospitals and other health care providers with a copay.  Or, you may seek care from an out-of-network provider for 80% coverage of reasonable and customary charges, The plan encourages but does not require  members to select a Primary Care Provider (PCP). Members pay lower office visit copays when they see Tier 1 or Tier 2 specialists.  Contact the plan to see if your provider is in the network and how he/she is rated. The plan also tiers hospitals based on quality and and/or cost; members pay a lower inpatient hospital copay when they use Tier 1 or Tier 2 hospitals.  Contact the plan to see which tier your hospital is in.
  • Harvard Pilgrim Primary Choice Plan HMO

    The Harvard Pilgrim Primary Choice Plan, administered by Harvard Pilgrim Health Care, is an HMO plan that provides coverage through the plan’s network of doctors, hospitals and other providers. Members must select a Primary Care Provider (PCP) to manage their care, including referrals to specialists. Members pay lower office visit copays when they see Tier 1 or Tier 2 specialists.  Contact the plan to see if your provider is in the network and how he/she is rated.  The plan also tiers hospitals based on quality and/or cost; members pay a lower inpatient hospital copay when they use Tier 1 hospitals.  Contact the plan to see which tier your hospital is in.
  • Health New England HMO

    Health New England is an HMO that provides coverage through the plan’s network of doctors, hospitals, and other providers.  Members must select a Primary Care Provider (PCP) to manage their care; referrals to network specialists are not required. Members pay lower office visit copays when they see Tier 1 or Tier 2 specialists.  Contact the plan to see how your provider is rated.

  • NHP Care - Neighborhood Health Plan HMO

    NHP Care, administered by Neighborhood Health Plan, is an HMO that provides coverage through the plan’s network of doctors, hospitals, and other providers.  Members must select a Primary Care Provider (PCP) to manage their care and obtain referrals to specialists.  Members pay lower office visit copays when they see Tier 1 and Tier 2 physicians.  Contact the plan to see how your provider is rated.

  • Tufts Health Plan Navigator PPO

    Tufts Health Plan Navigator is a PPO plan that offers coverage through network doctors, hospitals and other health care providers with a copay.  Or, you may seek care from an out-of-network provider for 80% coverage of reasonable and customary charges. The plan encourages but does not require members to select a Primary Care Provider (PCP). Members pay lower office visit copays when they see Tier 1 and Tier 2 specialists.  Contact the plan to see if your provider is in the network and how he/she is rated. The plan also tiers hospitals based on quality and/or cost; members pay a lower inpatient hospital copay when they use Tier 1 hospitals.  Contact the plan to see which tier your hospital is in. The mental health benefits of this plan, administered by Beacon Health Strategies, offer you in-network benefits with a copay.  Or, you may seek care from out-of-network providers, but at higher out-of-pocket costs.
  • Tufts Health Plan Spirit EPO (HMO-type)

    Tufts Health Plan Spirit is an Exclusive Provider Organization (EPO) plan that provides coverage through the plan’s network of doctors, hospitals and other providers.  The plan encourages but does not require members to select a Primary Care Provider (PCP). Members pay lower office visit copays when they see Tier 1 and Tier 2 specialists.  Contact the plan to see if your provider is in the network and how he/she is rated.  The plan also tiers hospitals based on quality and/or cost; members pay a lower inpatient hospital copay when they use Tier 1 hospitals.  Contact the plan to see which tier your hospital is in.
  • UniCare State Indemnity Plan/Basic Indemnity

    The UniCare State Indemnity Plan/Basic offers access to any licensed doctor or hospital throughout the United States and outside of the country. Massachusetts members pay lower office visit copays when they see Tier 1 or Tier 2 specialists.  Contact the plan to see how a physician is rated. If you use non-Massachusetts doctors or hospitals, contact the plan to find out which providers in your area that participate in UniCare's National Network of Providers. Mental health benefits administered by Beacon Health Strategies include Network providers with a copayment or out-of-network providers at higher out-of-pocket-costs.  Prescription drug benefits are administered by CVS Caremark.  

  • UniCare State Indemnity Plan / Community Choice PPO-Type

    The UniCare State Indemnity Plan/Community Choice is a PPO-type plan with a hospital network based at community and some tertiary hospitals.  Or, you may seek care from an out-of-network hospital for 80% coverage of the allowed amount for inpatient care and outpatient surgery, after you pay a copay. Contact the plan to see if your hospital is in the network. The plan offers access to all Massachusetts physicians and members are encouraged but not required to select a Primary Care Provider (PCP).  Members pay lower office visit copays when they see Tier 1 and Tier 2 specialists. Contact the plan to see how a physician is rated. The mental health benefits of this plan, administered by Beacon Health Strategies, offer you a choice of using network providers and paying a copayment, or seeking care from out-of-network providers at higher out-of-pocket costs.  Prescription drug benefits are administered by CVS Caremark.
  • UniCare State Indemnity Plan / PLUS PPO-Type

    The UniCare State Indemnity Plan/PLUS is a PPO-type plan that provides access to all Massachusetts physicians and hospitals and out-of-state UniCare providers at 100% coverage, after a copayment.  Out-of-state non-UniCare providers have 80% coverage of allowed charges. The plan encourages but does not require members to select a Primary Care Provider (PCP). Members pay lower office visit copays when they see Tier 1 and Tier 2 specialists.  Contact the plan to see how a physician is rated.  The plan also tiers hospitals based on quality and/or cost; members pay a lower inpatient hospital and outpatient surgery copay when they use Tier 1 or Tier 2 hospitals.  Contact the plan to see which tier your hospital is in. The mental health benefits of this plan, administered by Beacon Health Stategies, offer you a choice of using network providers and paying a copayment or seeking care from out-of-network providers at higher out-of-pocket costs.  Prescription drug benefits are administered by CVS Caremark.
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