Emergency and urgent care coverage*

Emergency medical care

Find emergency room copayments on your member ID card

  • The number after "ER" is your copayment for emergency room visits. 

The plan covers emergency care worldwide.

  • When you experience an emergency medical condition you should go to the nearest emergency room for care or call your local emergency communications system (e.g., police or fire department, or 911) to request ambulance transportation.
  • Emergency services don't require referral or authorization, but you must notify the plan of any emergency services that you receive.

Urgent care

Sometimes you may need care right away for minor emergencies such as cuts that require stitches, a sprained ankle or abdominal pain. These situations may not pose as much of a threat as the emergency situations discussed above, but they still require fast treatment to prevent serious deterioration of your health.

  • If you are within the FCHP service area, call your primary care provider's office for information on how and where to seek treatment. If your doctor isn't available, an on-call doctor will make arrangements for your care.
  •  If you are outside the FCHP service area, go to the nearest medical facility for care. If you need follow-up care, you should contact your PCP for assistance.

You may pay copayments for the services below; you also may be responsible for a deductible for certain services.

What's covered?

Service or procedure
Emergency room visits
Urgent care visits in a doctor’s office or at an urgent care facility
Emergency prescription medication provided out of the FCHP service area as part of an approved emergency treatment

Ambulance transportation for an emergency

What isn't covered?

Service or procedure
Nonemergency care provided in an emergency room
Unauthorized urgent care visits in the FCHP service area
Out-of-service area care or services that could have been anticipated before leaving the FCHP service area
Follow-up care, unless provided by your PCP, a Fallon Clinic specialist (if you have a Fallon Clinic PCP), or authorized by the plan. This exclusion includes follow-up care in an emergency room setting.
Nonemergency prescription medication outside the FCHP service area such as medication for a chronic condition or a maintenance supply. You may use the prescription medication mail-order program to fill medication refills. (See prescription medication coverage.)
Care from an out-of-network or out-of-service area provider once you are medically able to return to the FCHP service area.

Ambulance, chair van and/or medivan use for patient convenience, nonclinical reasons or transportation services only, including elective chair van transport from long-term care facilities to medical appointments

Transfers between hospitals when your medical condition does not warrant that you be transported to another facility
Air ambulance, when not appropriate to medical and geographical conditions.

Commercial airline transportation

For details on your specific benefits, coverage, and copayments:

  • Refer to your Member Handbook, Benefit Summary or Schedule of Benefits
    or
  • Call our customer service department at:
    1-800-868-5200 (TDD/TTY: 877-608-7677), Monday through Friday, 8 a.m. to 6 p.m.

* Benefits and coverage may vary by product, plan design and employer.  For specific details regarding your FCHP plan, benefits and features, please check with your employer or contact a member of our customer service team at 1-800-868-5200 (TDD/TTY: 1-877-608-7677), Monday through Friday, 8 a.m. to 6 p.m. Eastern time.  MassHealth members can call the MassHealth Customer Service Center at: 1-800-841-2900 (TDD/TTY: 1-800-497-4648) Monday through Friday, 8 a.m. to 5 p.m.