Your benefits and costs

  • 2016 benefits
  • 2015 benefits

Select Care

Plan overview

A network of more than 42,000 doctors, hospitals and community medical centers throughout Massachusetts and southern New Hampshire.

Deductible

$150/$300

Out-of-pocket maximum $3,500/$8,750

PCP wellness exams

$0 per visit

Other PCP office visits

$20 per visit

Specialist visits

$40 per visit

Routine eye exams

$20 per visit

Allergy injections

$5 per visit

Preventive services*

Covered in full

Outpatient lab and X-ray

Non-Hospital Setting: Covered in full
Hospital Setting: 10% coinsurance after deductible

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

Non-Hospital Setting: Covered in full, after deductible
Hospital Setting: 10% coinsurance, after deductible

Telemedicine

$0 per visit

Chiropractic care (20 visits per calendar year)

$20 per visit

Acupuncture (20 visits per calendar year)

$20 per visit

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

$150 per visit, after deductible

Urgent care/Mini clinics

$20 per visit

Inpatient hospital

$350 copayment per admission after deductible

Outpatient surgery

$200 copayment after deductible

Select Care

The Advantage Plan

Plan overview

A network of more than 42,000 doctors, hospitals and community medical centers throughout Massachusetts and southern New Hampshire.

Same great benefits and network, but the network is tiered, saving you money on your premium and Tier 1 doctors and hospitals.

Deductible

None

Tier 1:
None

Tier 2:
$1,000 individual/$2,000 family

PCP wellness exams

$0 per visit

$0 per visit

Other PCP office visits

$15 per visit

Tier 1:
$10 per visit

Tier 2:
$25 per visit

Specialist visits

$30 per visit

Tier 1:
$25 per visit

Tier 2:
$40 per visit

Routine eye exams

$15 per visit

$10 per visit

Allergy injections

$5 per visit

$5 per visit

Preventive services*

Covered in full

Covered in full

Diagnostic services**

Covered in full

Tier 1:
Covered in full

Tier 2:
Covered in full after deductible

Outpatient lab

Non-Hospital Setting: Covered in full
Hospital Setting: 10% coinsurance

Tier 1:
Covered in full

Tier 2:
Covered in full after deductible

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

Non-Hospital Setting: Covered in full
Hospital Setting: 10% coinsurance

Non-Hospital Setting: $50 copayment
Hospital Setting: $100 copayment

Telemedicine

$0 per visit $0 per visit

Chiropractic care (20 visits per calendar year)

$15 per visit

$10 per visit

Acupuncture (20 visits per calendar year)

$15 per visit

$10 per visit

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

$100 per visit

$100 per visit

Urgent care/Mini clinics

$15 per visit

$25 per visit

Inpatient hospital

$350 copayment per admission

Tier 1:
$150 copayment per admission

Tier 2:
$150 copayment per admission (after deductible)

Outpatient surgery

$75 copayment

Tier 1:
$75 copayment

Tier 2:
$150 copayment (after deductible)

 

Extra services

  • Fitness reimbursement—the most flexible fitness benefit of all your health plan options, annually reimbursing families and individuals $300 for participating in healthy activities, like school and town sports, exercise classes, ski lessons, ski lift tickets, gym memberships at the gym of your choice, and even home fitness equipment.
    Learn more about the fitness reimbursement (pdf) »
  • Out-of-area student coverage
  • Worldwide emergency care

* 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 and services intended to diagnose, check the status of, or treat a disease or condition.

Important information