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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 find out if your hospital is in the network.
The plan offers access to all Massachusetts physicians and members are encouraged to select a Primary Care Provider (PCP).
The behavioral 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. Beacon also offers EAP services. Prescription drug benefits are administered by CVS Caremark.
UniCare tiers Massachusetts specialists based on quality and/or cost efficiency Members pay lower office visit copays when they see Tier 1 and Tier 2 specialists. Contact the plan to see how a physician is rated.
Are your hospitals in the UniCare Community Choice network?
Contact the Plan.
Contact the plan for additional information on participating providers and benefits.
Medical BenefitsUniCare 1.800.442.9300
Behavioral Health, Substance Use Disorder and EAP BenefitsBeacon Health Options 1.855.750.8980
Prescription Drug Benefits
1.877.876.7214 TDD: 1-800-238-0756
CVS Caremark for Existing Members
CVS Caremark for Prospective Members
$500 per individual/$1,000 per family.
Prescription Drug Deductible
$100 per individual/$200 per family
Medical & Behavioral Health:
$4,000 per individual: $8,000 per family.
$1,500 per individual: $3,000 per family.
Primary Care Provider Office Visit
$20 per visitPreventive Services
Most covered at 100% - no copay
Specialist Office Visit
UniCare tiers Massachusetts specialists based on quality and/or cost efficiency. Contact the plan to see how your provider is rated.
***Tier 1 (excellent): $30 per visit
**Tier 2 (good): $60 per visit
*Tier 3 (standard): $90 per visit
Retail Clinic and Urgent Care Center
$20 per visit
Outpatient Behavioral Health and Substance Use Disorder Care (See the Attached grid UniCare Community Choice for additional benefit details.)
Beacon also offers EAP services.
Inpatient Hospital Care - Medical (Maximum one copay per person per calendar year quarter; waived if readmitted within 30 days in the same calendar year)
$275 per admission
Outpatient Surgery (Maximum one copay per person per calendar year quarter)
$110 per occurrence
High-Tech Imaging(e.g., MRI, PET and CT scans) (Maximum one copay per day)
$100 per scan
$100 per visit (waived if admitted)
Retail up to 30-day s Mail Order up to 90-day supply:
Tier 1: $10 Tier 1: $25
Tier 2: $30 Tier 2: $75
Tier 3: $65 Tier 3: $165
Employees, Retirees, Survivors, and their eligible dependents without Medicare are eligible.
Where You Live Determines Which Plan You May Enroll In
The UniCare State Indemnity Plan/Community Choice is available in the following Massachusetts counties:
Barnstable, Berkshire, Bristol, Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, Worcester
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