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 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.

Fallon Senior Plan is a Medicare plan under contract with the federal government that includes Medicare Part D prescription drug benefits and extra coverage from the GIC.  Contact the plan for details.  This Medicare plan’s benefits and rates are subject to federal approval and may change January 1, 2017.

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, 2016

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)

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?

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

Handbooks

Calendar Year 2016 Fallon Senior Plan Schedule of Benefits  doc format of Fallon_Senior_CY16SOB.doc

Calendar Year 2016 Fallon Senior Plan Evidence of Coverage  docx format of Fallon_Senior_CY16EOC.docx


This information provided by the Group Insurance Commission .