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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
Tier 1, 2 and 3 measurements of plan physician quality and 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 quality and efficiency. 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 quality and efficiency. 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 quality and efficiency. You will pay a higher copayment when you see a Tier 3 plan physician.
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 efficiency 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): $20 per visit
Tier 2**(good): $30 per visit
Tier 3*(standard): $40 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, $50 for Tier 3 (retail up to a 30-day supply)
$20 for Tier 1, $50 for Tier 2, $110 for Tier 3 (mail order up to 90-day supply)
Note: A generic preferred program is now in place. This means that
if you fill a prescription with a brand-name drug when a generic is available, you
will be responsible for the drug copayment plus the cost of the difference
between the two drugs.
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Vision
You are covered for one routine eye examination in each 24-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 mental health copayment: Covered in full
- Inpatient substance abuse care copayment: Covered in full, up to 30 days per calendar year
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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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High-end radiology
Includes MRI, PET, and CT.
Copayment: $75 (maximum one copayment per day)
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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 Medical Center
- Baystate Mary Lane Hospital
- Berkshire Medical Center
- Beth Israel Deaconess Medical Center*
- Beverly Hospital
- Boston Medical Center*
- Brigham and Women’s Hospital*
- Caritas Good Samaritan Medical Center
- Caritas Norwood Hospital
- Caritas Saint Elizabeth’s Medical Center*
- Charlton Memorial Hospital
- Children’s Hospital
- Clinton Hospital
- Cooley Dickinson Hospital
- Dana-Farber Cancer Institute*
- Emerson Hospital
- Fairview Hospital
- Faulkner Hospital
- Harrington Memorial Hospital
- HealthAlliance Hospitals
- Heywood Hospital
- Holy Family Hospital and Medical Center
- Holyoke Medical Center
- Hubbard Regional Hospital
- Jordan Hospital
- Lahey Clinic
- Lawrence General Hospital
- Lawrence Memorial Hospital
- Lowell General Hospital
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- Marlborough Hospital
- Massachusetts General Hospital*
- Melrose-Wakefield Hospital
- Mercy Medical Center
- Merrimack Valley Hospital
- MetroWest Medical Center
- Milford Regional Medical Center
- Morton Hospital and 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 Hospital
- North Shore Medical Center—Union Hospital
- Quincy Medical Center
- Saint Luke's Hospital
- Saint Vincent Hospital
- Saints Memorial Medical Center
- Signature Healthcare Brockton Hospital
- South Shore Hospital
- Sturdy Memorial Hospital
- Tobey Hospital
- Tufts Medical Center*
- 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 $400 ($200 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 ChooseHealthy™, 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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