GIC Health Plan Options

UniCare State Indemnity Plan/Community Choice
Eligibility
Plan Contact Information
Plan Service Area

Plan Overview
The UniCare State Indemnity Plan/ Community Choice is a PPO-type plan that does not require members to select a Primary Care Physician (PCP).  The plan offers access to all Massachusetts physicians.  Members receive greater benefits when they see Tier 1 or Tier 2 physicians.   Contact the plan to see how your physician is rated. 
Hospital care co-pays and deductibles are determined by the type of treatment.  For routine procedures, members receive the highest benefit when choosing one of the plan’s hospitals, most of which are community hospitals.   For certain complex procedures, additional hospitals are available at the highest benefit.  Otherwise, members pay a higher hospital deductible when they seek care from a hospital that is not in the plan. Contact the plan to see if the hospitals you are likely to use are Community Choice hospitals.

The mental health benefits of this plan, administered by United Behavioral Health (UBH), offer you a choice of using network providers and paying a co-payment, or seeking care from out-of-network providers at higher out-of-pocket costs.


In-Network Benefits effective July 1, 2008
UniCare tiers Massachusetts physicians based on quality and cost efficiency standards.

Primary Care Physician Office Visit
Tier 1 (excellent):  100% after $10 per visit
Tier 2 (good):       100% after $20 per visit
Tier 3:  (standard): 100% after $25 per visit

Specialist Physician Office Visit
Tier 1 (excellent):  100% after $15 per visit
Tier 2 (good):  100% after $20 per visit
Tier 3:  (standard): 100% after $35 per visit

Outpatient Mental Health and Substance Abuse Care (contact UBH for other mental health and substance abuse benefit details)
100% after $15 per visit
UBH also offers EAP services.

Inpatient Hospital Care – Medical (maximum one deductible per person per calendar year quarter; waived if readmitted within 30 days in the same calendar year)
100% after $200 deductible

Outpatient Surgery
100% after $100 deductible (maximum one deductible per person per calendar year quarter)

Emergency Room
100% after $50 co-pay per visit (waived if admitted)


Prescription Drug Co-payments
Retail up to 30-day supply:                    Mail Order up to 90-day supply:
Tier 1: $7                                                    Tier 1:   $14
Tier 2: $20                                                   Tier 2:   $40
Tier 3: $40                                                   Tier 3:   $90
Value Tier: $2                                             Value Tier: $4
Specialty drug mail order up to 30 day supply: $10

Eligibility
Employees, Retirees, Survivors, and their eligible dependents  without Medicare are eligible.  Members must live in the Plan’s service area.

Service Area
The UniCare State Indemnity Plan/Community Choice is available in the following Massachusetts counties:  Barnstable,  Berkshire, Bristol,  Dukes,  Essex,  Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, Worcester
                     
Monthly Rates as of July 1, 2008

Plan Contact Information
Contact the Plan for additional information on
participating providers and benefits.

Medical Benefits:
UniCare
1.800.442.9300

Mental Health, Substance Abuse and EAP Benefits:
United Behavioral Health (access code: 10910)
1.888.610.9039

Prescription Drug Benefits
Express Scripts
1.877.828.9744