Plan Overview

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. 

The plan determines allowed amounts for out of state providers; you may be responsible for a portion of the total charge.  To avoid these additional provider charges, if you use non-Massachusetts doctors or hospitals, contact the plan to find out which doctors and hospitals in your area participate in UniCare’s national network of providers. 

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.

Plan Contact Information

Contact the plan for additional information on benefits and the national network of providers.

Medical Benefits:
UniCare 1.800.442.9300

Mental Health, Substance Abuse and EAP Benefits:
Beacon Health Strategies 1.855.750.8980

Prescription Drug Benefits
CVS Caremark 1.877.876.7214 TDD 1.800.238.0756

Calendar Year Deductible

$250 per individual up to a maximum of $750 per family. 

In-Network Out-Of-Pocket Maximum

Excludes Prescription Drug Cost

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


Copays with CIC (Comprehensive) Effective July 1, 2014

Without CIC deductibles are higher and coverage is only 80% for some services. Contact the plan for details.

Primary Care Provider Office Visit
$20 per visit
Preventive Services

Most covered at 100% - no copay

Specialist Office Visit UniCare tiers Massachusetts specialists based on quality and/or cost efficiency. Contact the plan to see how your provider is rated.
***Tier 1 (excellent):           $25 per visit
 **Tier 2 (good):                 $35 per visit
    *Tier 3:  (standard):        $45 per visit

Retail Clinic

$20 per visit

Network Outpatient Mental Health and Substance Abuse Care (See the UniCare Basic doc format of    Beacon_benefit_grid_UniCareBasic_FY15.doc   grid for employees and retirees or the UniCare Basic grid for RMTs and EGRs doc format of    Beacon_benefit_grid_UniCareBasicRMTEGR_FY15.doc  grid for additional benefit details) 

$20 per visit

Beacon also offers EAP services.


Inpatient Hospital Care – Medical (Maximum one copay per person per calendar year quarter; waived if readmitted within 30 days in the same calendar year)
$200 per admission

Outpatient Surgery (Maximum one copay per person per calendar year quarter)

$110 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                                                                Mail Order up to 90-day supply:

up to 30-day supply:
Tier 1:   $10                                                                Tier 1:   $20
Tier 2:   $25                                                                Tier 2:   $50
Tier 3:   $50                                                                Tier 3:   $110

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

The UniCare State Indemnity Plan/Basic is the only Non-Medicare plan offered by the GIC that is available throughout the United States and outside of the country.

Handbooks

UniCare State Indemnity Plan Basic FY14 Handbook doc format of    UniCare State Indemnity Plan Basic FY14 Handbook  file size 1MB - for employees and Non-Medicare retirees (Series 1)

UniCare State Indemnity Plan Basic FY14 Handbook doc format of    UniCare State Indemnity Plan RMT FY14 Handbook  file size 3MB - for retirees in the Retired Municipal Teacher (RMT) and EGR programs (series 3)

This information provided by the Group Insurance Commission.