Prospective members who are shopping for a plan
To download a benefit summary, Summary of Benefits and Coverage (SBC) or schedule of benefits, click the "See more" link that corresponds to your plan's effective date below. For Evidence of Coverage (EOC) documents, click the links in the "Evidence of Coverage" box to the right.

Current members
You can view and download your specific plan documents by logging into myFallon.

For individuals who get insurance through a large employer*
The plan documents below are only a sample. Benefits, copayments, coinsurance and deductible amounts can vary by each employer.

  • If you are shopping for a new plan, please check with your HR/Benefits Administrator for your employer’s actual plan documents.
  • If you are a current Fallon member, you can log in to myFallon to see your current plan documents.

Download the Glossary of Health Coverage and Medical Terms (pdf)

* Currently, a large employer is defined as an employer with more than 50 full-time, benefit-eligible employees. During 2016, the definition will change so that an employer will be considered a large employer if it has more than 100 full-time equivalent employees.

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.

Steward Community 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 Steward Community Care. Please visit our Find a Doctor tool or consult the Steward Community Care provider directory to determine which providers are included in Steward Community Care. A paper copy can be requested by calling our Customer Service Department at 1-800-868-5200.

Tiered Choice provides access to a network that is smaller than the Select Care provider network, and includes the tiered provider network called Tiered Choice. In this plan, members have access to network benefits only from the providers in Tiered Choice, 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 January 1. Please visit our Find a Doctor tool or consult the Tiered Choice provider directory to determine which providers are included in Tiered Choice. A paper copy can be requested by calling our Customer Service Department at 1-800-868-5200.

* A “large employer” is an employer with more than 100 full-time equivalent employees during the preceding calendar year,

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