Your benefits

Two HMO plans to choose from!

By offering two plans - Direct Care and Select Care - Fallon gives you the flexibility to choose a network and level of benefits that best fit your health care needs.

Download summaries of benefits:

What's the difference between the two plans?

FCHP Direct Care and Select Care networks give you options
Direct Care Select Care
  • More than 28,000 providers across Massachusetts
  • Tiered limited network plan with coverage in Central and Eastern Massachusetts
  • Saves you money on your health insurance premium
FCHP Direct Care is a limited network plan

  • More than 40,000 providers
  • A larger, tiered network with coverage throughout Massachusetts, Southern New Hampshire and Southwestern Vermont
List of network providers and hospitals »

Benefits and copayments

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

Direct Care Select Care
Deductibles

$300 Indiv and $900 Family

$300 Indiv and $900 Family

Out-of-pocket maximum $5,000/$10,000
PCP wellness exams $0 per visit $0 per visit
Other PCP office visits $15 per visit $20 per visit
Urgent care center/Retail clinic ("Minute Clinic")

Find an in-network clinic

$15 per visit $20 per visit
Ob/Gyn visits 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: $90 per visit Tier 1: $30 per visit Tier 2:
$60 per visit
Tier 3:
$90 per visit
Prescriptions*
(up to a 90-day supply)
$10/$30/$65 $10/$30/$65
Mail-order prescriptions*
(up to a 90-day supply)
$25/$75/$165 $25/$75/$165
Prilosec OTC, Prevacid 24hr, Omeprazole OTC (prescription required) $10 $10
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)

For more detailed information on benefits and copayments:

Healthy extras

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

* 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 difference between the two drugs.

** 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.

Direct Care provides access to a network that is smaller than Select Care. In this plan, members have access to network benefits only from the providers in Direct Care. Please consult the Direct Care provider directory—a paper copy can be requested by calling our Customer Service Department at 1-866-344-4442—or visit the provider search tool to determine which providers are included in Direct Care.

Select Care members have access to network benefits only from the providers in Select Care, and may pay different levels of copayments, coinsurance and/or deductibles depending on the tier of the provider delivering a covered service or supply. This plan may make changes to a provider’s benefit tier annually on July 1. Please consult the Select Care provider directory—a paper copy can be requested by calling our Customer Service Department at 1-866-344-4442—or visit the provider search tool to determine which providers are included in Select Care.

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