GIC Health Plan Options

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

Plan Overview
Fallon Community Health Plan Select 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 plan’s network of doctors, hospitals, and other providers.  There are no out-of-network benefits, with the exception of emergency care.  Members pay lower co-pays when they see Tier 1 or Tier 2 physicians. Contact the plan to see if your provider is in the network and how he/she is rated.


Benefits effective July 1, 2008
Fallon Community Health Plan tiers network physicians based on quality and cost-efficiency standards.

Primary Care Physician Diagnostic Office Visit
Tier 1 (excellent):   100% after $10 per visit
Tier 2 (good):   100% after $15 per visit
Tier 3 (standard): 100% after $25 per visit

Specialist Office Visit
Tier 1 (excellent):   100% after $15 per visit
Tier 2 (good):   100% after $25 per visit
Tier 2 (standard): 100% after $35 per visit

Primary Care Physician Wellness Office Visit
Tier 1 (excellent):   100% after $10 per visit; 100% after $0 per pediatric visit
Tier 2 (good):   100% after $15 per visit; 100% after $5 per pediatric visit
Tier 3 (standard): 100% after $25 per visit; 100% after $10 per pediatric visit

Outpatient Mental Health and Substance Abuse Care
100% after $15 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 $250 per admission

Outpatient Surgery (maximum four co-pays annually per person)
100% after $125 per occurence

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 Select Care is available in the following Massachusetts counties:
Berkshire, Bristol, Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Suffolk, Worcester

Fallon Community Health Plan Select Care is partially available in the following Massachusetts county: Plymouth
The plan may not be available in every city and town in this county.  Contact the plan for details.
                     
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