Broker FAQ

To better serve our Fallon Community Health Plan brokers, we've compiled some of the most frequently asked questions below.

Don't see your question listed here? Let us know and we'll work on adding it to our list!

On this page:

Question:
What's the difference between FCHP Select Care and FCHP Direct Care?

Answer:
FCHP Direct Care is a subset of the FCHP Select Care network, custom-built around some of the state’s premier physician groups and hospitals, giving you access to quality providers at a significantly lower premium cost.

FCHP Select Care offers a much broader choice of providers to help us better meet the needs of employers who have personnel throughout western, central and eastern Massachusetts. Members can choose from thousands of providers and contracted hospitals throughout the state, including the Bay State Health system, Anna Jaques Hospital, Emerson Hospital, Fallon Clinic, Greater Milford Health Alliance, Lawrence General Hospital, Merrimack Valley Hospital, Mount Auburn Cambridge IPA, Nashoba Valley Medical Center Northeast Medical Associates, UMass Memorial Health Care and Winchester Hospital.

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Question:
How do I find out the name of my assigned sales executive?

Answer:
Contact Ursula Arello, 1-508-368-9454.

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Question:
What factors go into FCHP's rating methodology?

Answer:
Fallon Community Health Plan utilizes the following factors for pricing purposes:

For groups with fewer than 51 lives:

  • Subscriber age
  • Region (based on employer ZIP code)
  • Family status

For groups with more than 51 lives:

  • Subscriber age
  • Subscriber gender
  • Subscriber ZIP code or subscriber health care option*
  • Employer industry
  • Family mix

* ZIP codes are used for pricing prospective business; Health care options (based on member-level primary care physician) are used for renewal pricing.

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Question:
Are rates affected by broker involvement?

Answer:
Broker commissions are part of FCHP's overall administrative cost and rates are not loaded or discounted based on the involvement of a broker.

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Question:
What are FCHP's participation guidelines?

Answer:
Fallon Community Health Plan prefers that all employees enrolled by the Employer into the Plan are full-time employees working 30 hours or more per week (including any owners of the business) or part-time employees working at least 20 hours per week and receiving an employer contribution (of at least 50% of the premium) toward the health insurance coverage.

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Question:
What's the difference between Fallon Clinic and FCHP?

Answer:
Fallon Community Health Plan is a health maintenance organization, while Fallon Clinic is a physician group practice.

FCHP is a nonprofit, mixed-model HMO that provides health insurance coverage for its members through a network of professionals and hospitals. FCHP offers a range of health plan options to meet the needs of employers of all sizes. We ensure that our members have access to quality care and services through hundreds of private practice physicians in Massachusetts, as well as to Fallon Clinic, FCHP's founding medical group.

Fallon Clinic is a multispecialty group practice, which began in 1929, where specialists and primary care providers work closely together to provide high-quality health care for the community. Over the years, Fallon Clinic has expanded their practice and retained physicians from some of the best medical schools in the country to provide patients with high-quality care using advanced technology.

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Question:
Does FCHP cover out-of-state employees?

Answer:
FCHP has several plans that will cover out-of-state employees. Fallon Preferred Care is a preferred provider organization (PPO) which has a network of nearly 450,000 providers and over 4000 health care facilities nationwide.

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Question:
Does FCHP offer a qualified high-deductible health plan that's compatible with a health savings account?

Answer:
Yes, FCHP has a full array of qualified high-deductible health plans available through FCHP Care Choice.

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