The Fallon Health Select Care is closed to new members. See the Benefit Change section for more information.

Plan Overview

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. 

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. 

Specialist and Hospital Tiering

Fallon Health tiers specialists based on quality and/or cost efficiency. Members pay lower copays when they see Tier 1 or Tier 2 specialists. Contact the plan to see how your provider 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 or Tier 2 hospitals.  Contact the plan to see which tier your hospital is in.

! Your Responsibility

Do your doctors and hospitals participate in Fallon Select?

Contact the plan.

Plan Contact Information

Contact the plan for additional information on
participating providers and benefits.

Fallon Health 1.866.344.4442

 

Fiscal Year Deductible

$550 per individual up to a maximum of $1,100 per family. 

In-Network Out-of-Pocket Maximum

$5,000 per individual; $10,000 per family

Copays Effective July 1, 2017

Primary Care Physician Office Visit

$20 per visit.

Preventive Services

Most covered at 100% - no copay

Specialist Office Visit

Fallon Health tiers specialists based on quality and/or cost efficiency. Contact the plan to see how your provider is rated.

***Tier 1 (excellent):          $30 per visit
 **Tier 2 (good):                $60 per visit
   *Tier 3 (standard):          $90 per visit

Retail Clinic and Urgent Care Center

$20 per visit

Outpatient Behavioral Health and Substance Use Disorder Care

$20 per visit

 

Inpatient Hospital Care – Medical (Maximum one copay per person per calendar year quarter; waived if readmitted within 30 days in the same calendar year)

Tier 1:           $275 per admission
Tier 2:           $500 per admission
Tier 3:           $1,500 per admission

Contact the plan to see which tier your hospital is in.

Outpatient Surgery: (Maximum four copays per person per calendar year)

$125 per occurrence

 

High-Tech Imaging (e.g., MRI, PET and CT scans) (Maximum one copay per day)

$100 per scan

Emergency Room
$100 per visit (waived if admitted)

Prescription Drug

Retail up to 30-day supply:        Mail Order up to 90-day supply:
Tier 1:   $10                            Tier 1:   $25
Tier 2:   $30                            Tier 2:   $75
Tier 3:   $65                            Tier 3:   $165

Who is Eligible?

Employees, Retirees, GIC Retired Municipal Teachers (RMTs), Elderly Governmental Retirees (EGRs), Survivors, and their eligible dependents without Medicare are eligible. 

Where You Live Determines Which Plan You May Enroll In

Fallon Health Select Care is available in  the following Massachusetts counties:

Berkshire, Bristol, Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, Worcester

Fallon Health Select Care is available only in certain parts of the following state; contact the plan to find out if you live in the service area:

New Hampshire

Handbooks

FY18 Fallon Select Handbook  doc format of FY18 Fallon Select Handbook

FY18 Fallon Select Handbook  pdf format of FY18 Fallon Select Handbook

FY17 Fallon Select Schedule of Benefits  doc format of FY17 Fallon Select Schedule of Benefits
 

FY17 Fallon Select Schedule of Benefits  pdf format of FY17 Fallon Select Schedule of Benefits


This information provided by the Group Insurance Commission .