1-866-344-4442 (TRS 711)
Mon., Tue., Thu., Fri.: 8 a.m. to 6 p.m. Wed: 10 a.m. to 6 p.m.

Plans and benefits

Our plans - Direct Care and Select Care - offer different networks and levels of benefits to best fit your health care needs.

Download summaries of benefits:

What's the difference between the two plans?

There are two main differences between Direct Care and Select Care: network and benefits.

1. Network

Direct Care Select Care
  • More than 26,000 providers across Massachusetts
  • Tiered limited network plan with coverage in Central and Eastern Massachusetts
  • Saves you money on your health insurance premium

 

  • A larger, tiered network with more than 47,000 providers throughout Massachusetts, Southern New Hampshire and Southwestern Vermont

    Learn more about tiering »

List of network providers and hospitals »

 

2. Benefits and copayments

The chart below shows your copayments for some of the most commonly used benefits.

Direct Care Select Care

Medical deductible

$400 Individual
$800 Family

$500 Individual
$1,000 Family

Rx deductible
Administered through
Express Scripts
855-283-7679
express-scripts.com

$100 Individual
$200 Family

$100 Individual
$200 Family

Learn more about deductibles (pdf)

Out-of-pocket maximum

$5,000/$10,000

$5,000/$10,000

PCP wellness exams

$0 per visit

$0 per visit

Other PCP office visits

$15 per visit

$20 per visit

Teladoc®
Telehealth medical consultations

$15 per consult

$15 per consult

Urgent care center/Retail clinic ("Minute Clinic")

Find an in-network clinic

$15 per visit

$20 per visit

Ob/Gyn visits
Prenatal and postnatal care

Tier 1:
$10 per visit

Tier 2:
$15 per visit

Tier 3:
$25 per visit

Tier 1:
$15 per visit

Tier 2:
$20 per visit

Tier 3:
$30 per visit

Specialist visits

Tier 1:
$30 per visit

Tier 2:
$60 per visit

Tier 3:
$75 per visit

Tier 1:
$30 per visit

Tier 2:
$60 per visit

Tier 3:
$75 per visit

Prescriptions

Drug coverage provided by Express Scripts
Contact: 855-283-7679 or express-scripts.com

$10/30/65 Retail
$25/75/165 Mail-order

$10/30/65 Retail
$25/75/165 Mail-order

Routine eye exams

$15 per visit

$20 per visit

Outpatient mental health and substance abuse

$15 per visit

$20 per visit

Preventive services**

Covered in full

Covered in full

Diagnostic services***

Subject to deductible then covered in full

Subject to deductible then covered in full

Imaging (CAT, PET, MRI scans) (max. of one copayment per day)

$100 copayment (then subject to deductible)

$100 copayment (then subject to deductible)

Chiropractic care
(12 visits per benefit year)

$15 per visit

$20 per visit

Emergency services
(Copayments for ER services are waived if you are admitted to the hospital)

$100 copayment (then subject to deductible)

$100 copayment (then subject to deductible)

Inpatient hospital

$275 copayment per admission
(then subject to deductible)

Tier 1:
$275

Tier 2:
$500

Tier 3:
$1,500

Copayment, then subject to deductible

Outpatient surgery

$250 copayment (then subject to deductible)

$250 copayment (then subject to deductible)

 

Healthy extras

With either Direct Care or Select Care, you'll get:

  • One of the most flexible fitness reimbursements in the state
    - Direct Care members - $400/family, $200/individual
    - Select Care members - $100/family, $100/individual
  • A 20% discount on CVS/pharmacy-brand health-related products
  • Eyewear discounts – save up to 35% on frames and get additional discounts on contact lenses, laser vision correction and nonprescription sunglasses
  • Quit to Win – smokers have access to this free counseling program with tobacco cessation experts who will work with you by telephone
  • And other healthy extras that you won't find with any other plan

Learn more about healthy extras »

 

Additional information about our health plan benefits and policies

Find out about our Case Management, Disease Management, Behavioral Health, and more. 
Download information about your benefits and policies (pdf) »

 

 

** Preventive services are tests, immunizations and services geared to help screen for diseases and improve early detection when symptoms or diagnosis are not present.

*** Diagnostic services are tests, immunizations and services that are intended to diagnose, check the status of, or treat a disease or condition.