Consider Enrolling in a Less Expensive Plan

Benefits of lower cost plans.

Take action during Annual Enrollment! Be sure to “GIC”

Gather – a list of doctors, hospitals and medications for everyone you cover
Investigate – your options by reading the Benefit Decision Guide and contacting the health plans you’re considering. Find out if your doctors and hospitals are in the network. Find out the copay tiers of the providers. Find out if your prescription drugs are in your plan's formulary and what copay tier they are in. Finally, find out the total expected costs you could incur.
Choose - your health plan and return the necessary completed forms to your GIC coordinator (if you are an active employee) or to the GIC directly (if you are a retiree) no later than Wednesday, May 2, 2018.

Limited Network Plans offer an affordable option

Limited network plans help address differences in provider costs.  You will enjoy the same benefits as the wider network plans, but will save money because limited network plans have a smaller network of providers (fewer doctors and hospitals).  Your savings depend on:

  • The plan you are switching from.
  • The plan you select.
  • Your premium contribution percentage, and
  • Whether you have individual or family coverage.

For example, if you pay 25% of the premium and have individual coverage, by enrolling in the same health plan’s limited network option instead of a wide network option, you will save, on average, $45.72 per month and $548.67 per year.

See the health plan pages for rates to determine what the savings would be for the plans you are considering.

Find out if your hospital is in a GIC limited network plan

Download a side-by-side comparison of the five limited network plans and their participating hospitals at the bottom of the page.

For participating physician and other provider details, contact the individual plans by phone or visit their website.

The GIC’s limited network plans are:

  • Fallon Health Direct Care - an HMO available throughout central Massachusetts, Metro West, Middlesex County, the North Shore and the South Shore. The plan includes 29 area hospitals and another six “Peace of Mind” hospitals in Boston that provide second opinions and care for very complex cases.
  • Harvard Pilgrim Primary Choice Plan - an HMO with a network of 56 hospitals. The plan is available throughout Massachusetts, except for Cape Cod, Martha’s Vineyard, and Nantucket.
  • Health New England - a western and central Massachusetts-based HMO that includes 20 Massachusetts hospitals.
  • Tufts Health Plan Spirit – an EPO (HMO-type) plan with a network of 54 hospitals. The plan is available throughout Massachusetts, except for Martha’s Vineyard, Nantucket and parts of Berkshire and Hampshire Counties.
  • UniCare State Indemnity Plan/Community Choice - a PPO-type plan with a network of 58 hospitals. All Massachusetts physicians participate. The plan is available throughout Massachusetts, except for Martha's Vineyard and Nantucket.

Other health plan options

If you don’t want a limited network plan, take a look at NHP Prime and UniCare State Indemnity Plan/PLUS.

Your responsibility before you enroll in a plan

Once you choose a plan you, cannot change health plans during the year, unless you move out of the plan’s service area.  If your doctor or hospital leaves your health plan, you must find a new participating provider in your chosen plan.

  • Check if your doctors participate in the plan.
  • Find out if the doctors’ affiliated hospitals are in the plan.
  • Keep in Mind:  Doctors and hospitals can leave a plan during the year, usually because of health plan and provider contract issues, practice mergers, retirement or relocation.

Reminders

  • Each July 1, physician and hospital copay tiers can change. During annual enrollment, check to see if your doctor’s or hospital’s tier has changed.
  • When checking provider coverage and tiers by contacting health plans, make sure to specify the health plan’s full name, such as “Tufts Health Plan Spirit” or “Tufts Health Plan Navigator,” not just “Tufts Health Plan.”
  • Your health plan selection is binding until the next annual enrollment, even if your doctor or hospital leaves your health plan’s network during the year. However, your health plan will help you find another provider.

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