|The Fallon Health Select Care is closed to new members. See the Benefit Change section for more information.|
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
$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.
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
$100 per visit (waived if admitted)
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:
This information provided by the Group Insurance Commission .