GIC Health Plans for Active/Retired State and Municipal Employees without Medicare

Health plan options offered by the Group Insurance Commission available to current state employees, state retirees and survivors, and municipal employees without Medicare

Fallon Health Care Direct HMO

Fallon Health Direct Care is an HMO that requires members to select a Primary Care Physician (PCP) to manage their care and obtain referrals to specialists. There are no out-of-network benefits, with the exception of emergency care.

Learn more about Fallon Health Direct

Fallon Health Select Care HMO

Fallon Health Select Care is an HMO that provides coverage through the plan’s network of doctors, hospitals, and other providers.  Members must select a Primary Care Provider (PCP) to manage their care and obtain referrals to specialists. 

Learn more about Fallon Health Select

Harvard Pilgrim Independence Plan POS

The Harvard Pilgrim Independence Plan is a Point of Service (POS). 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. Members who get care from specialists without a PCP referral have higher out-of-pocket costs.

Learn more about Harvard Independence

Harvard Pilgrim Primary Choice Plan HMO

The Harvard Pilgrim Primary Choice Plan, administered by Harvard Pilgrim Health Care, is an HMO plan that provides coverage through the plan’s network of doctors, hospitals and other providers. Members must select a Primary Care Provider (PCP) to manage their care, including referrals to specialists.

Learn more about Harvard Primary Choice

Health New England HMO

Health New England is an HMO that provides coverage through the plan’s network of doctors, hospitals, and other providers.  Members must select a Primary Care Provider (PCP) to manage their care; referrals to network specialists are not required. 

Learn more about Health New England

NHP Prime - Neighborhood Health Plan HMO

NHP Prime, administered by Neighborhood Health Plan, is an HMO that provides coverage through the plan’s network of doctors, hospitals, and other providers.  Members must select a Primary Care Provider (PCP) to manage their care and obtain referrals to specialists.  

Learn more about Neighborhood Health Plan

Tufts Health Plan Navigator POS

Tufts Health Plan Navigator is a Point-of-Service (POS) plan. 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. Members who get care from specialists without a PCP referral have higher out-of-pocket costs.

Learn more about Tufts Navigator

Tufts Health Plan Spirit EPO (HMO-type)

Tufts Health Plan Spirit is an Exclusive Provider Organization (EPO) plan that provides coverage through the plan’s network of doctors, hospitals and other providers.  The plan encourages but does not require members to select a Primary Care Provider (PCP). The mental health benefits of this plan are administered by Beacon Health Options.

Learn more about Tufts Spirit

UniCare State Indemnity Plan/Basic

The UniCare State Indemnity Plan/Basic offers access to any licensed doctor or hospital throughout the United States and outside of the country. The Plan determines allowed amounts for out-of-state providers; you may be responsible for a portion of the total charge.  To avoid these additional charges, if you use non-Massachusetts doctors or hospitals, contact the plan to find out which providers in your area participate in UniCare's National Network.  Mental health benefits administered by Beacon Health Options include network providers with a copayment or out-of-network providers at higher out-of-pocket-costs.  Prescription drug benefits are administered by CVS Caremark.  

Learn more about UniCare Basic

UniCare State Indemnity Plan/Community Choice PPO-Type

The UniCare State Indemnity Plan/Community Choice is a PPO-type plan with a hospital network of community and some tertiary hospitals at 100% coverage, after a copayment.  Or, you may seek care from an out-of-network hospital at 80% coverage of the allowed amount for inpatient care and outpatient surgery, after you pay a copay. Contact the plan to see if your hospital is in the network. The plan offers access to all Massachusetts physicians and members are encouraged but not required to select a Primary Care Provider (PCP).  The mental health benefits of this plan, administered by Beacon Health Options, offer you a choice of using network providers and paying a copayment, or seeking care from out-of-network providers at higher out-of-pocket costs.  Prescription drug benefits are administered by CVS Caremark.

Learn more about UniCare Community Choice

UniCare State Indemnity Plan/PLUS (PPO-Type)

The UniCare State Indemnity Plan/PLUS is a PPO-type plan that provides access to all Massachusetts physicians and hospitals and out-of-state UniCare providers at 100% coverage, after a copayment.  Out-of-state non-UniCare providers have 80% coverage of allowed charges. Members are encouraged but not required to select a Primary Care Provider (PCP).  The mental health benefits of this plan, administered by Beacon Health Options, offer you a choice of using network providers and paying a copayment or seeking care from out-of-network providers at higher out-of-pocket costs.  Prescription drug benefits are administered by CVS Caremark.

Learn more about UniCare PLUS

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