Benefit summaries and Summaries of Benefits and Coverage (SBC) for our health insurance plans
A variety of low cost plan designs with flexible benefit options and a choice of networks.
To download a benefit summary or SBC for your current plan year, click the "See more" link that corresponds to your plan's effective date. Please note: These documents do not include customizations. These are the standard plan designs. If you need documents for a plan with an earlier effective date, please contact Jen Lavigne at jennifer.lavigne@fallonhealth.org.
Quick look at plans
January 1, 2017 effective dates and beyond
2017
Effective dates of January 1, 2017 and beyond
| Copay: affordable options that include inpatient copayments at premium savings |
| Direct Care network (HMO) |
Select Care network (HMO) |
| Copay 500
|
Copay 500
|
| Copay 1000 Hybrid
|
Copay 1000 Hybrid
|
| Coinsurance: plan designs that provide premium savings by offering coinsurance for inpatient services and diagnostic testing |
| Direct Care network (HMO) |
Select Care network (HMO) |
| Coinsurance 35%
|
Coinsurance 35%
|
| Deductible: plan designs that provide premium savings by offering deductibles for inpatient services and diagnostic testing |
| Direct Care network (HMO) |
Select Care network (HMO) |
Preferred Care network (PPO) |
| Deductible 1000 Classic
|
Deductible 1000 Classic
|
|
| Deductible 1200 Hybrid
|
Deductible 1200 Hybrid
|
|
| Deductible 1500 Classic
|
Deductible 1500 Classic
|
|
| Deductible 2000 Classic
|
Deductible 2000 Classic
|
|
| Deductible 2000 Hybrid
|
Deductible 2000 Hybrid
|
|
| Deductible 2000 Low
|
Deductible 2000 Low
|
Deductible 2000 Low
|
| Bronze Deductible 3000
|
Bronze Deductible 3000
|
|
| Deductible 3000 Classic
|
Deductible 3000 Classic
|
|
| QHD: qualified high deductible plans that may be partnered with a Health Savings Account (HSA) |
| Direct Care network (HMO) |
Select Care network (HMO) |
Preferred Care network (PPO) |
| QHD 2000 HSA
|
QHD 2000 HSA
|
QHD 2000 HSA
|
| QHD 3000 HSA
|
QHD 3000 HSA
|
|
Connector plans - individuals and families
| Direct Care network (HMO) |
Select Care network (HMO) |
| Catastrophic plan
|
|
| Deductible 2000 Hybrid
|
|
| |
Silver Coinsurance 35%
|
| Silver Connector
|
Silver Connector
|
| Bronze Connector
|
Bronze Connector
|
| Bronze Deductible 3000
|
Bronze Deductible 3000
|
| Gold Connector A
|
Gold Connector A
|
| Gold Connector B
|
Gold Connector B
|
| Platinum Connector
|
Platinum Connector
|
Subsidy plans
| Community Care |
| Silver Coinsurance 35%
|
| Wrap Type I
|
| Wrap Type II
|
| Wrap Type III
|
2016
Effective dates of January 1, 2016 and beyond
| Copay: affordable options that include inpatient copayments at premium savings |
| Direct Care network (HMO) |
Select Care network (HMO) |
| Copay 500
|
Copay 500
|
| Copay 1000 Hybrid
|
Copay 1000 Hybrid
|
| Coinsurance: plan designs that provide premium savings by offering coinsurance for inpatient services and diagnostic testing |
| Direct Care network (HMO) |
Select Care network (HMO) |
| Coinsurance 35%
|
Coinsurance 35%
|
| Deductible: plan designs that provide premium savings by offering deductibles for inpatient services and diagnostic testing |
| Direct Care network (HMO) |
Select Care network (HMO) |
Preferred Care network (PPO) |
| Deductible 1000 Hybrid
|
Deductible 1000 Hybrid
|
|
| Deductible 1000 Classic
|
Deductible 1000 Classic
|
|
| Deductible 1500 Classic
|
Deductible 1500 Classic
|
|
| Deductible 2000 Classic
|
Deductible 2000 Classic
|
|
| Deductible 2000 Hybrid
|
Deductible 2000 Hybrid
|
|
| Deductible 2000 Low
|
Deductible 2000 Low
|
Deductible 2000 Low
|
| Bronze Deductible 3000
|
Bronze Deductible 3000
|
|
| Deductible 3000 Classic
|
Deductible 3000 Classic
|
|
| QHD: qualified high deductible plans that may be partnered with a Health Savings Account (HSA) |
| Direct Care network (HMO) |
Select Care network (HMO) |
Preferred Care network (PPO) |
| QHD 2000 HSA
|
QHD 2000 HSA
|
QHD 2000 HSA
|
| QHD 3000 HSA
|
QHD 3000 HSA
|
|
Connector plans - individuals and families
| Direct Care network (HMO) |
Select Care network (HMO) |
| Catastrophic plan
|
|
| Deductible 2000 Hybrid
|
Deductible 2000 Hybrid
|
| Bronze Deductible 3000
|
Bronze Deductible 3000
|
| Platinum Connector A
|
Platinum Connector A
|
| Gold Connector A
|
Gold Connector A
|
| Gold Connector B
|
Gold Connector B
|
| Silver Connector A
|
Silver Connector A
|
Subsidy plans
| Community Care |
| Silver Connector A
|
| Wrap Type I
|
| Wrap Type II
|
| Wrap Type III
|
Direct Care is a plan with a limited provider network. This plan 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 visit our Find a Doctor tool or consult the Direct Care provider directory to determine which providers are included in Direct Care. A paper copy can be requested by calling our Customer Service Department at 1-800-868-5200.