GIC Health Plan Options

Fallon Community Health Plan Direct Care
Eligibility
Plan Contact Information
Plan Service Area

Plan Overview
Fallon Community Health Plan Direct Care is an HMO that requires members to select a Primary Care Physician (PCP) to manage their care.  With an HMO, you receive care through the pPlan’s network of doctors, hospitals and other providers.  There are no out-of-network benefits, with the exception of emergency care.  Fallon Direct Care offers a selective network based at a geographically concentracted network of physician group practices, community hospitals, and medical facilities.  Contact the plan to see if your provider is in the network.


Benefits effective July 1, 2008

Primary Care Physician Office Visit
100% after $10 per visit; 100% pediatric wellness visit

Specialist Physician Office Visit 
100% after $15 per visit

Outpatient Mental Health and Substance Abuse Care
100% after $10 per visit

Inpatient Hospital Care – Medical (maximum four co-pays per person per calendar year; waived if readmitted within 30 days in the same calendar year)
100% after $200 per admission

Outpatient Surgery
100% after $100 per occurrence (maximum four co-pays annually per person)

Emergency Room
100% after $75 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: $10                                                   Tier 1:   $20
Tier 2: $25                                                   Tier 2:   $50
Tier 3: $40                                                   Tier 3:   $90


Eligibility
Employees, Retirees, survivors, Retired Municipal Teachers (RMTs), Elderly Governmental Retirees (EGRs), and their eligible dependents without Medicare are eligible.   Members  must live in the plan’s service area.

Service Area
Fallon Community Health Plan Direct Care is available in the following Massachusetts counties: Essex, Middlesex
Fallon Community Health Plan Direct Care is partially available in the following Massachusetts counties.  The plan may not be available in every city and town in these counties.  Contact the plan for details: Hampden, Hampshire, Norfolk, Suffolk, Worcester
                     
Monthly Rates as of July 1, 2008

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

Fallon Community Health Plan
1.866.344.4442