offered by
related to

GIC Non-Medicare Health Insurance Products

Find out more information about the different health plans the GIC offers and pick the one that is best for your needs.

Table of Contents

Doctor with clipboard

Prescription Drugs

Express Scripts (ESI)

In an effort to help GIC members save on pharmaceutical costs, the GIC has contracted with Express Scripts (ESI) to manage the prescription drug benefit for all GIC non-Medicare medical products beginning July 1, 2018. You will receive a separate ID card that you will be required to use when filling your prescriptions. You will be able to access a broad network of retail pharmacies to fill a 30-day supply and can fill a 90-day supply through mail order or at a CVS Pharmacy.

Find an ESI provider

Learn more about Express Scripts

National Network

UniCare State Indemnity Plan/Basic with CIC (Comprehensive)

About the Product:
• Provides access to any licensed doctor or hospital throughout the United States and outside of the country*
• In Massachusetts, provides 100% coverage of allowed charges after copay and deductible
• Members are encouraged to select a Primary Care Provider (PCP) to manage their care and pay a lower copay if they see a Centered Care PCP

What’s changing for this plan year:
• Reduced copay from $90 to $75 for third-tier specialists
• New combined medical and pharmacy out-of-pocket maximum ($5,000/$10,000)
• New vendor for prescription drug coverage: Express Scripts
• Emergency ambulance (no charge after deductible)

Find a UniCare provider 

Learn more about UniCare Basic

UniCare Basic with CIC Summary of Benefits and Coverage

UniCare Basic without CIC Summary of Benefits and Coverage

UniCare Basic Benefit Handbook

Broad Network

UniCare State Indemnity Plan/PLUS (PPO-Type)

About the Product:
• Provides access to all Massachusetts physicians and hospitals; also provides access to the carrier’s network of physicians and providers throughout New England and border states, with in and out-of-network benefits
• Out-of-state non-UniCare providers have 80% coverage of allowed charges*
• Members are encouraged to select a Primary Care Provider (PCP) to manage their care and pay a lower copay if they see a Centered Care PCP
• Members will pay lower copays for Tier 1 and Tier 2 PCPs and specialists and Tier 1 and Tier 2 hospitals

What’s changing for this plan year:
• Reduced copay from $90 to $75 for third-tier specialists
• New combined medical and pharmacy out-of-pocket maximum ($5,000/$10,000)
• New vendor for prescription drug coverage: Express Scripts
• Emergency ambulance (no charge after deductible)
• Expansion of in-network coverage area in New England and border states

Find a UniCare provider

Learn more about UniCare PLUS

UniCare Plus Summary of Benefits and Coverage

UniCare Plus Benefit Handbook

Tufts Health Plan Navigator POS

About the Product:
• Provides coverage for treatment by a network of doctors, hospitals and other health care providers
• Members must select a Primary Care Provider (PCP) to manage their care and obtain referrals to specialists to receive care at the in-network level of coverage
• The product allows treatment by out-of-network providers or in-network care without a Primary Care Provider (PCP) referral, but with higher out-of-pocket costs
• Members will pay lower copays for Tier 1 or Tier 2 PCPs and specialists and Tier 1 or Tier 2 hospitals

What’s changing for this plan year:
• Reduced copay from $90 to $75 for third-tier specialists
• For members 21 and under, new $2,000 per hearing aid per impaired ear every 24 months
• Emergency ambulance (no charge after deductible)
• New vendor for prescription drug coverage: Express Scripts

Find a Tufts provider

Learn more about Tufts Navigator

Tufts Navigator Summary of Benefits and Coverage

Tufts Navigator Benefit Handbook

Fallon Health Select Care HMO

About the Product:
• Provides coverage through the carrier’s network of doctors, hospital and other providers
• Members must select a Primary Care Provider (PCP) to coordinate their care and obtain referrals to specialists
• No out-of-network benefits are provided, with the exception of emergency care
• Members will pay lower office visit copays when they see Tier 1 or Tier 2 specialists and use Tier 1 or Tier 2 hospitals

What’s changing for this plan year:
• Separate medical and prescription drug deductible: $500 (individual)/$1,000 (family) for medical and $100 (individual)/ $200 (family) for prescription drugs
• Reduced copay from $90 to $75 for third-tier specialists
• For members 21 and under, new $2,000 per hearing aid per impaired ear every 24 months
• New vendor for prescription drug coverage: Express Scripts
• New $15 copay for Telehealth visits

Find a Fallon provider

Learn more about Fallon Health Select

Fallon Select Care Summary of Benefits and Coverage

Fallon Select Care Schedule of Benefits Handbook

Fallon Select Care Member Handbook

Harvard Pilgrim Independence Plan POS

About the Product:
• A POS product that provides coverage for treatment by a network of doctors, hospitals and other health care providers
• Members must select a Primary Care Provider (PCP) to manage their care and obtain referrals to specialists to receive care at the in-network level of coverage
• The product allows treatment by out-of-network providers or in-network care without a Primary Care Provider (PCP) referral, but with higher out-of-pocket costs
• Members will pay lower copays for Tier 1 or Tier 2 PCPs and specialists and Tier 1 or Tier 2 hospitals

What’s changing for this plan year:
• Reduced copay from $90 to $75 for third-tier specialists
• For members 21 and under, new $2,000 per hearing aid per impaired ear every 24 months
• Emergency ambulance (no charge after deductible)
• New vendor for prescription drug coverage: Express Scripts

Find a Harvard Pilgrim provider

Learn more about Harvard Independence

Harvard Pilgrim Independence Summary of Benefits and Coverage

Harvard Pilgrim Independence Benefit Handbook

Harvard Pilgrim Prescription Handbook

Regional Network

Health New England HMO

About the Product:
• Provides coverage through the carrier’s network of doctors, hospital and other providers
• Members must select a Primary Care Provider (PCP) to coordinate their care; referrals to network specialists are not required
• No out-of-network benefits are provided, with the exception of emergency care
• Members will pay lower office visit copays when they see Tier 1 or Tier 2 specialists

What’s changing for this plan year:
• Lower medical deductible: $400 (individual)/$800 (family)
• Reduced copay from $90 to $75 for third-tier specialists
• Emergency ambulance (no charge after deductible)
• For members 21 and under, new $2,000 per hearing aid per impaired ear every 24 months
• New vendor for prescription drug coverage: Express Scripts
• New $15 copay for Telehealth visits

Find a Health New England provider 

Learn more about Health New England

Health New England Summary of Benefits and Coverage

Health New England Handbook HMO Handbook

AllWays Health Partners HMO

About the Product:
• Provides coverage through the carrier’s network of doctors, hospital and other providers
• Members must select a Primary Care Provider (PCP) to coordinate their care and obtain referrals to specialists
• No out-of-network benefits are provided, with the exception of emergency care
• Members will pay lower office visit copays when they see Tier 1 or Tier 2 specialists

What’s changing for this plan year:
• Reduced copay from $90 to $75 for third-tier specialists
• For members 21 and under, new $2,000 per hearing aid per impaired ear every 24 months
• New vendor for prescription drug coverage: Express Scripts
• New $15 copay for Telehealth visits

Find an AllWays provider

Learn more about AllWays Health Partners

AllWays Health Partners Summary of Benefits and Coverage

AllWays Health Partners Benefit Handbook

Limited Network

UniCare State Indemnity Plan/Community Choice PPO-Type

About the Product:
• Product with a hospital network of community hospitals and some tertiary hospitals in Massachusetts, provides 100% coverage of allowed charges after copayment and deductible
• Members have the option to seek care from an out-of-network hospital for 80% coverage of the allowed amount for inpatient care and outpatient surgery, after paying a copay
• The product offers access to all Massachusetts physicians and members are encouraged to select a Primary Care Provider (PCP)
• Members will pay lower office visit copays when they see Tier 1 or Tier 2 specialists

What’s changing for this plan year:
• Lower medical deductible from $500 (individual)/$1,000 (family) to $400 (individual)/$800 (family)
• Reduced copay from $90 to $75 for third-tier specialists
• New combined medical and pharmacy out-of-pocket maximum ($5,000/$10,000)
• Lowered copay for Patient Centered PCPs from $20 to $15
• For members 21 and under, new $2,000 per hearing aid per impaired ear every 24 months
• New vendor for prescription drug coverage: Express Scripts

Find a UniCare provider

Learn more about UniCare Community Choice

UniCare Community Choice Summary of Benefits and Coverage

UniCare Community Choice Benefit Handbook

Tufts Health Plan Spirit EPO (HMO-Type)

About the Product:
• Provides coverage through the carrier’s network of doctors, hospitals and other providers
• Members are encouraged to select a Primary Care Provider (PCP)
• No out-of-network benefits are provided, with the exception of emergency care
• Members will pay lower office visit copays when they see Tier 1 or Tier 2 specialists and Tier 1 Hospitals

What’s changing for this plan year:
• Lower medical deductible: from $500 (individual)/$1,000 (family) to $400 (individual)/$800 (family)
• Reduced copay from $90 to $75 for third-tier specialists
• Reduced inpatient hospital copay to $275 for Tier 1 and $500 for Tier 2
• For members 21 and under, new $2,000 per hearing aid per impaired ear every 24 months
• New vendor for prescription drug coverage: Express Scripts

Find a Tufts provider

Learn more about Tufts Spirit

Tufts Spirit Summary of Benefits and Coverage

Tufts Spirit Benefit Handbook

Fallon Health Care Direct HMO

About the Product:
• The product offers a limited network based in a geographically concentrated area
• Provides coverage through the carrier’s network of doctors, hospital and other providers
• Members must select a Primary Care Provider (PCP) to coordinate their care and obtain referrals to specialists
• No out-of-network benefits are provided, with the exception of emergency care
• Members will pay lower office visit copays when they see Tier 1 or Tier 2 specialists

What’s changing for this plan year:
• Separate medical and prescription drug deductible: $400 (individual)/$800 (family) for medical and $100 (individual)/ $200 (family) for prescription drugs.
• Reduced copay from $90 to $75 for third-tier specialists
• New vendor for prescription drug coverage: Express Scripts

Find a Fallon provider

Learn more about Fallon Health Direct

Fallon Direct Care Summary of Benefits and Coverage

Fallon Direct Care Schedule of Benefits Handbook

Fallon Direct Care Member Handbook

Harvard Pilgrim Primary Choice Plan HMO

About the Product:
• Provides coverage through the carrier’s network of doctors, hospital and other providers
• Members must select a Primary Care Provider (PCP) to coordinate their care and obtain referrals to specialists
• No out-of-network benefits are provided, with the exception of emergency care
• Members will pay lower office visit copays when they see Tier 1 specialists and Tier 1 hospitals

What’s changing for this plan year:
• Lower medical deductible: from $500 (individual)/$1,000 (family) to $400 (individual)/$800 (family)
• For members 21 and under, new $2,000 per hearing aid per impaired ear every 24 months
• New vendor for prescription drug coverage: Express Scripts
• New $15 copay for Telehealth visits

Find a Harvard Pilgrim provider

Learn more about Harvard Primary Choice

Harvard Pilgrim Primary Choice Summary of Benefits and Coverage

Harvard Pilgrim Primary Choice Benefit Handbook

Harvard Pilgrim Prescription Handbook

Contact

Phone

Main Phone (617) 727-2310

M-F 8:45 a.m.-5 p.m.

TDD/TTY 711

Fax

Operations (617) 227-2681
Executive (617) 227-5181
Fiscal (617) 367-9874

Address

Street Address
19 Staniford St
Boston, MA 02114
Mailing Address
P.O. Box 8747
Boston, MA 02114
Image credits:  Shutterstock

Feedback

Did you find what you were looking for on this webpage? * required
We use your feedback to help us improve this site but we are not able to respond directly. Please do not include personal or contact information. If you need a response, please locate the contact information elsewhere on this page or in the footer.
We use your feedback to help us improve this site but we are not able to respond directly. Please do not include personal or contact information. If you need a response, please locate the contact information elsewhere on this page or in the footer.

If you need to report child abuse, any other kind of abuse, or need urgent assistance, please click here.

Feedback