Plan Overview
Fallon Senior Plan is a Medicare Advantage HMO plan that provides coverage through the plan’s network of doctors, hospitals, and other providers. Members must select a Primary Care Physician (PCP) to manage their care, including referrals to specialists.
Contact the plan to see if your doctors and hospitals are in the network. There are no out-of-network benefits, with the exception of emergency care.
Fallon Senior Plan is a Medicare plan under contract with the federal government that includes Medicare Part D prescription drug benefits. Contact the plan to see for details. This Medicare plan’s benefits and rates are subject to federal approval and may change January 1, 2014.
Your Responsibility
Do your doctors and hospitals participate in Fallon Senior Plan?
Contact the plan.
Plan Contact Information
Contact the plan for additional information on
participating providers and benefits.
Fallon Senior Plan 1.866.344.4442
Copays Effective January 1, 2013
Physician Office Visit
$10 per visit
Preventive Services
Covered at 100% - no copay
Outpatient Mental Health and Substance Abuse Care
$10 per visit
Inpatient Hospital Care
Covered at 100% - no copay
Inpatient and Outpatient Surgery
Covered at 100% - no copay
Emergency Room
$50 per visit (waived if admitted)
Retail up to 30-day supply: Mail Order up to 90 day supply:
Tier 1: $10 Tier 1: $20
Tier 2: $25 Tier 2: $50
Tier 3: $50 Tier 3: $110
Who is Eligible?
Retirees, GIC Retired Municipal Teachers (RMTs), Elderly Governmental Retirees (EGRs), Survivors, and their eligible dependents with Medicare Part A and Part B are eligible.
Where You Live Determines Which Plan You May Enroll In:
Fallon Senior Plan is available in the following Massachusetts counties:
Barnstable, Bristol, Essex, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, Worcester
Fallon Senior Plan is available only in certain parts of the the following Massachusetts county; contact the plan to find out if you live in the service area:
Franklin
Fallon Senior Plan is only available in certain parts of the following states; contact the plan to find out if you live in the service area:
Connecticut, New Hampshire, Rhode Island
Fallon Community Health Senior Plan Schedule Of Benefits Handbook CY12 
Fallon Community Health Senior Plan Evidence Of Coverage Handbook CY12 file size 6MB
This information provided by the Group Insurance Commission.
