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FCHP Select Care
Below is a list of the major services that FCHP Select Care covers. For a complete
list of benefits and coverage, please download the documents below.
Download a full, printable summary of benefits
Download the Select Care Member Handbook (coming soon)
Tier 1,
2 and 3 measurements of plan physician quality and cost-efficiency
Fallon Community Health Plan is committed to giving all our members access to a network of high-quality,
cost-efficient plan physicians. The tiering
works as follows:
***Tier 1 (excellent): Plan physicians practicing at an excellent level of cost-efficiency
and quality. You will pay the lowest copayment when you see a Tier 1 plan physician.
**Tier 2 (good): Plan physicians practicing at a good level of cost-efficiency and
quality. Also included in this tier’s copayment are providers that didn’t have sufficient
data with which to rate them, and providers that belong to a specialty or subspecialty that is not being tiered by the health plan.
*Tier 3 (standard): Plan physicians practicing at a standard level of cost-efficiency
and quality. You will pay a higher copayment when
you see a Tier 3 plan physician.
Note: Copayments to visit plan providers in specialties that are not tiered, for
example mental health and substance abuse providers, chiropractors and optometrists,
will not be tiered and will have a copayment of $15.
Also, please be aware that the tiering level of plan physicians will be re-evaluated
on an annual basis. The re-evaluation may result in a change to a plan physician’s
tiering level. You should check the annual provider directory or the "Find
a doctor" tool for annual tiering level changes.
The plan physician quality and cost-efficient measures are only one factor you should
consider when selecting
a primary care physician or specialty physician. Tier 1
plan physicians may not be available in certain areas.
Office visits
FCHP Select Care covers routine physical exams, short-term rehabilitative services,
speech therapy, prenatal and postnatal care, and chiropractic care. Limits apply
to rehabilitative services and chiropractic care.
Copayment
Tier 1*** (excellent): $0 per visit for child wellness exam and $10 per visit for all
other visits.
Tier 2**(good): $5 per visit for child wellness exam and $15 per visit for all other visits.
Tier 3*(standard):$10 per visit for child wellness exam and $25 per visit for all other visits.
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Specialist services
FCHP Select Care also covers office visits for a number of specialist providers
not listed above.
Copayment
Tier 1***(excellent): $15 per visit
Tier 2**(good): $25 per visit
Tier 3*(standard): $35 per visit
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Prescriptions
You are covered for any prescription medication listed on Fallon Community Health
Plan’s drug formulary that is prescribed by a plan provider for a covered
medical condition. In addition to many community pharmacies and the PharmaCare pharmacies
located in Fallon Medical Centers, you can fill prescriptions at the following major
retail chains: CVS, Brooks, Walgreens, Target, Kmart, Wal-Mart, Shaw’s and
Stop & Shop.
Visit FCHP’s
online drug formulary
FCHP’s prescription formulary is broken into three tiers, or levels, with
a different copayment for each tier.
- Tier-1 drugs are primarily generic medications and have the lowest copayment.
- Tier-2 drugs are primarily preferred brand-name medications.
- Tier-3 drugs are generally brand-name medications that have a generic or equally
effective counterpart in a lower tier.
Copayment: $10 for Tier 1, $25 for Tier 2, $40 for Tier 3 (retail up to a 30-day supply)
$20 for Tier 1, $50 for Tier 2, $90 for Tier 3 (mail order up to 90-day supply)
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Vision
You are covered for one routine eye examination in each 12-month period. FCHP Select
Care members can receive eye examinations from any optometry provider in the FCHP
Select Care network. You do not need a referral. Just call the provider of your
choice and make an appointment.
Copayment: $15 per visit
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Mental health and substance abuse
FCHP Select Care covers unlimited outpatient visits for mental health and substance
abuse counseling as well as unlimited days in a general hospital
for mental health care and unlimited days for detoxification or rehabilitation services
in an inpatient setting.
- Outpatent visits copayment: $15 per visit
- Inpatient general hospital copayment: Covered in full
- Inpatient detoxification or rehabilitation services copayment: Covered in
full
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Emergency
Emergency services do not require referral or authorization. When you have an emergency
medical condition, you should go to the nearest emergency department or call your
local emergency communications system (police, fire department or 911). All emergency
room care must be reported to the plan within 48 hours.
Copayment: $75 per visit (waived if admitted)
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Hospital
FCHP Select Care covers unlimited days for room and board in a semiprivate room
(maximum of four copayments per year). The following is included in hospital services:
- Physicians’ and surgeons’ services
- Physical and respiratory therapy
- Intensive care services
- Prescribed
private duty nursing (when medically necessary)
- Maternity care
Copayment: $250 per admission (waived if readmitted within 30 days of discharge from an acute care or psychiatric hospital)
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Physician, provider, and hospital network
In addition to the physicians available in the FCHP Direct Care network plus physicians and facilities
throughout western, central, and eastern Massachusetts., FCHP Select Care also covers care at the
following
hospitals:
- Addison Gilbert Hospital
- Anna Jaques Hospital
- Athol Memorial Hospital
- Baystate Franklin Medical Center
- Baystate Mary Lane Hospital
- Baystate Medical Center
- Berkshire Medical Center**
- Beth Israel Deaconess Medical Center*
- Beverly Hospital
- Boston Medical Center*
- Brigham and Women's Hospital*
- Brockton Hospital
- Caritas Good Samaritan Medical Center
- Caritas Norwood Hospital
- Caritas Saint Elizabeth’s Medical Center*
- Children's Hospital
- Clinton Hospital
- Cooley Dickinson Hospital
- Dana-Farber Cancer Institute*
- Emerson Hospital
- Fairview Hospital**
- Harrington Memorial Hospital
- HealthAlliance Hospitals
- Heywood Hospital
- Holy Family Hospital and Medical Center
- Holyoke Medical Center
- Hubbard Regional Hospital
- Lahey Clinic
- Lawrence General Hospital
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Lawrence Memorial Hospital
Lowell General Hospital
Malden Medical Center
Marlborough Hospital
Massachusetts General Hospital*
Melrose-Wakefield Hospital
Mercy Medical Center
Merrimack Valley Hospital
MetroWest Medical Center
Milford Regional Medical Center
Mount Auburn Hospital
Nashoba Valley Medical Center
New England Baptist Hospital*
New England Medical Center*
Newton-Wellesley Hospital
Noble Hospital
North Adams Regional Hospital**
North Shore Medical Center - Salem Campus
North Shore Medical Center - Union Campus
Saint Vincent Hospital
Saints Memorial Medical Center
South Shore Hospital
Sturdy Memorial Hospital
UMass Memorial Medical Center - Memorial Campus
UMass Memorial Medical Center - University Campus
Whidden Memorial Hospital
Winchester Hospital
Wing Memorial Hospital
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* These facilities may only be available for certain services or for specialty care
through FCHP-authorized tertiary care or our Peace of Mind Program™.
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Wellness programs
Fitness
It Fits!, FCHP’s fitness reimbursement program, gives your family
up to $300 ($150 for individual contract) to use toward a variety of healthy activities,
like a membership at local fitness centers, aerobics, Pilates and yoga classes (when
taught by a certified instructor), Weight Watchers® programs, as well as local,
town and school sports programs for all ages.
Birth and baby
FCHP’s Oh Baby! is a health and wellness program that gives parents
the information and resources they need to help take care of the “little things”
in life. Participants will receive prenatal vitamins, a book on caring for their
child, and a convertible car seat, plus a few little extras—all at no additional
cost!
Alternative health care
Our Naturally Well program offers discounts on acupuncture, chiropractic
care (in addition to any chiropractic benefit your plan may have) and massage therapy
from the American Specialty Health Networks, Inc. (ASHN) credentialed network of
qualified providers. Health and wellness products also are available at a reduced
rate through Healthyroads, an affiliate of ASHN.
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Nurse Connect health coaching
Fallon Community Health Plan has joined with Health Dialog® to give FCHP members
complimentary access to registered nurses and other health care
professionals who serve as health coaches, 24 hours a day, seven days a week, 365
days a year. When you have a health question, you can immediately contact a health
coach who can provide personal education and support, information to help you make
healthy decisions, educational materials relevant to a diagnosis or condition, and
assistance with finding additional health information online.
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Online health education and decision tools
As a member of FCHP Select Care, you will gain access to a number of online health
education and decision tools designed to help keep you well:
- Online health coaching
- Hospital quality comparisons
- Health encyclopedias
-
Personal wellness profile
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