The UniCare State Indemnity Plan/Basic offers access to any licensed doctor or hospital throughout the United States and outside of the country. The plan determines allowed amounts for out-of-state providers; you may be responsible for a portion of the total charge. To avoid additional non-Massachusetts provider charges, contact UniCare to find doctors and hospitals who participate in UniCare’s national Anthem and Private Healthcare Systems (PHCS) network.
The behavioral health benefits of this plan, administered by Beacon Health Options, 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. Beacon also offers EAP services. Prescription drug benefits are administered by CVS Caremark.
UniCare tiers Massachusetts specialists based on quality and/or cost efficiency. 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.
Plan Contact Information
Contact the plan for additional information on benefits and the national network of providers.
Behavioral Health, Substance Use Disorder and EAP Benefits:
Beacon Health Options 1.855.750.8980
Prescription Drug Benefits
1.877.876.7214 TDD: 1-800-238-0756
CVS Caremark for Existing Members
CVS Caremark for Prospective Members
$500 per individual/$1,000 per family.
Prescription Drug Deductible
$100 per individual/$200 per family
In-Network Out-Of-Pocket Maximum
Medical & Behavioral Health:
$4,000 per individual; $8,000 per family.
$1,500 per individual; $3,000 per family.
Copays with CIC (Comprehensive) Effective July 1, 2017
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
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): $30 per visit
**Tier 2 (good): $60 per visit
*Tier 3 (standard): $90 per visit
Retail Clinic and Urgent Care Center
$20 per visit
Network Outpatient Behavioral Health and Substance Use Disorder Care (See the UniCare Basic grid for employees and retirees or the UniCare Basic grid for RMTs and EGRs 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)
$275 per admission
Outpatient Surgery (Maximum one copay per person per calendar year quarter)
$250 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 Mail Order up to 90-day supply:
up to 30-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
The UniCare State Indemnity Plan/Basic is the only health plan offered by the GIC that is available throughout the United States and outside of the country.
FY18 UniCare State Indemnity Plan/Basic Handbook - for employees and Non-Medicare retirees (Series 1)
FY18 UniCare State Indemnity Plan/Basic Handbook file size 1MB - for employees and Non-Medicare retirees (Series 1)
FY18 UniCare State Indemnity Plan/Basic Handbook - for retirees in the Retired Municipal Teacher (RMT) and EGR programs (Series 3)
FY18 UniCare State Indemnity Plan/Basic Handbook file size 2MB - for retirees in the Retired Municipal Teacher (RMT) and EGR programs (Series 3)
This information provided by the Group Insurance Commission .