Employer FAQ
To better serve our Fallon Community Health Plan employers, we have 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 are Employer Tools?
Answer:
Employer Tools give you access to online enrollment, secure file transfers from the FCHP Web site and the ability to drop off employer eligibility files in standardized formats.
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Question:
How do I register for Employer Tools?
Answer:
It's easy to register for Employer Tools! Just click here.
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Question:
What is the difference between FCHP Direct Care and FCHP Select 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.
The FCHP Select Care product offers a 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, Mount Auburn Cambridge IPA, Northeast Medical Associates and the UMass Memorial Health Care System. FCHP Select Care members also have access to a wide variety of bonus benefits and outstanding features.
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Question:
How do members select a physician?
Answer:
New members are required to select a primary care provider (PCP) from internal medicine, family practice or pediatrics. PCPs are listed in Provider Network directories along with physician assistants and nurse practitioners where available. The PCP has the primary responsibility for coordinating the overall health care for the member. PCPs are required under the contract with the plan to maintain 24-hour-a-day, 7-day-a-week coverage for plan members.
Members can search through a database of physicians online or contact the Customer Service Department. Customer service representatives, as well as representatives in the Access Department, are available to assist the member in selecting a PCP.
If a member does not select a PCP upon enrollment, a representative will follow up with the member through phone calls and letters requesting that the selection process be completed. A member who fails to select a PCP may be assigned to one in the appropriate geographic area.
Members may switch their PCP at any time, either online or by calling the Customer Service Department at 800-868-5200 (TDD/TTY: 877-608-7677).
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Question:
Where can members learn more about physicians than just their name and specialty?
Answer:
The Massachusetts Board of Registration in Medicine Physician Profile System offers a wealth of information on physicians registered to practice medicine in the Commonwealth. This includes education history, disciplinary actions, and honors and awards.
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Question:
What is 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 care 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 offer discounts on fitness center memberships?
Answer:
FCHP members receive reduced membership rates at contracted fitness facilities, allowing them use of amenities such as cardiovascular, strength and exercise equipment, and participation in fitness classes. The discounts on fitness centers vary depending on location. For details on participating fitness centers, members can consult the Provider Network directory of their plan or call FCHP Customer Service at 800-868-5200 (TDD/TTY: 877-608-7677).
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Question:
Does FCHP cover out-of-state employees?
Answer:
Fallon Community Health Plan has developed a number of options that allow you to provide coverage to your out-of-state employees.
Fallon Preferred Care (PPO)
Fallon Preferred Care is a preferred provider organization which has a network of nearly 450,000 providers and over 4000 health care facilities nationwide through Private Healthcare Systems.
General out-of-area care
FCHP members enjoy the security of coverage for out-of-area emergencies and urgently needed care (defined as care needed right away for a minor emergency, such as a cut that requires stitches, a broken limb or abdominal pain). Members are covered for the initial treatment of any emergency. An emergency medical condition is a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, with an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in: 1) serious jeopardy to the health of the individual (or unborn child); 2) serious impairment to bodily functions; or 3) serious dysfunction of any bodily organ or part. The member should go to the nearest emergency room for care. Fallon Community Health Plan requests that the member, or someone acting on his or her behalf, contact the member's primary care physician as soon as medically possible after receiving care.
In the case of urgently needed care that is not life-threatening, the member is instructed to seek care at the nearest medical facility if he or she is outside of their plan service area and to call FCHP as soon as medically possible.
We also cover specific services for students living outside of the service area, as long as they are authorized in advance. The services are subject to standard copayments and include:
- Nonroutine medical office visits
- Diagnostic lab and X-ray connected to a nonroutine office visit
- Nonelective inpatient services if we are notified within at least 48 hours of the admission
- Outpatient service to treat the abuse of or addiction to alcohol or drugs for up to 20 office visits per calendar year
- Outpatient services to diagnose and/or treat mental conditions
- Short-term rehabilitation services (including physical, occupational and speech therapy). Coverage for physical and occupational therapy is provided for up to 20 visits per calendar year per illness or injury (combined with any in-area visits). Coverage for speech therapy is determined by medical necessity.
The out-of-area student benefit excludes coverage for:
- Routine physicals
- Gynecological exams
- Vision screening and hearing screening
- Maternity care
- Routine preventive care
- Outpatient surgical procedures that could be delayed until return to our service area
- Durable medical equipment
- Preventive dental
- Second opinion
- Home health care
- Nonemergency prescription medicine
- Chiropractic services.
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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:
- 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:
What are FCHP's participation guidelines?
Answer:
Fallon Community Health Plan prefers that 75% of eligible full-time employees be enrolled in all health plans offered by the employer, excluding those who waive due to spousal coverage. Groups that have lower participation level will be quoted at the underwriter's discretion. FCHP requires the employee to work at least 30 hours per week for full-time or 20 hours part-time and receive an employer contribution to health care. FCHP can be offered alongside other carriers.
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Question:
What are the system requirements to use Employer Tools?
Answer:
The requirements to use the various Employer Tools are:
- an Internet connection (56K modem or high-speed connection)
- a Web browser (We recommend Internet Explorer 5.x or higher.)
- a username and password supplied by FCHP
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Question:
What if I need help using Fallon Community Health Plan's Employer Tools?
Answer:
We'll be happy to assist you. Please contact our EDI coordinators at 800-333-2535, ext. 69968, or via e-mail.
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Question:
How can I give Employer Tools access to new employees and remove access for employees who no longer work for me?
Answer:
To obtain access for new employees, please complete an Employer Tools Registration Form and send to:
Fallon Community Health Plan
Attn: EDI Coordinator
10 Chestnut St.
Worcester, MA 01608-2810
Download the Employer Tools Registration Form.
When someone leaves your organization, please contact FCHP at 800-333-2535, ext. 69968, to disable their access to Employer Tools. Also, if you feel the security of a password has been compromised, please notify FCHP immediately.
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Question:
How can I be sure the information is secure going over the Internet?
Answer:
This site uses 128-bit Secure Sockets Layer (SSL) encryption, the highest level of encryption currently available. Once you are logged into the FCHP Web site, all information transferred is sent using SSL. When you're accessing pages on www.fchp.org, there is a lock icon located on the bottom right of your browser window, which verifies that the site is secure. (Here is what it looks like - 
)
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Question:
Can another FCHP employer view my information?
Answer:
No. FCHP limits access to employer information by your employer identification number. FCHP is committed to keeping your information—and that of your employees—secure and confidential.
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Question:
I need to end coverage for an employee who was terminated one month ago. Why am I being told the termination effective date that I have entered is not correct?
Answer:
You can't enter a date outside of your retro period. The termination effective date is calculated by counting back the number of days in your retro period from the current date.
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