A new health plan for 2011: The City of Worcester Advantage

The City of Worcester Advantage, powered by Fallon Health , is a new health plan built exclusively for City of Worcester Advantage employees and their families. Developed in partnership with local Worcester providers, UMass Memorial Health Care, Saint Vincent Hospital and Reliant Medical Group (formerly Fallon Clinic), The City of Worcester Advantage offers two plan choices:

The Direct plan

Uses the Fallon Direct Care network. Providers in the Fallon Direct Care network are also in The City of Worcester Advantage Direct plan network.

  • Members of the Direct plan must choose a PCP from the network. Referral procedures mirror those of FCHP Direct Care.
  • To provide services to a member of the Direct plan you must be an FCHP Direct Care contracted provider.

The Advantage plan

Powered by the Fallon Select Care network, but uses tiering. Certain Central Massachusetts-based providers are in tier 1. All other Fallon Select Care providers are in tier 2 of this plan.

  • Tier 1 providers include: UMass Memorial Health Care, Saint Vincent Hospital, Reliant Medical Group (formerly Fallon Clinic), Clinton Hospital, Harrington Hospitals, HealthAlliance Hospitals, Heywood Hospital, Marlborough Hospital, Milford Hospital, Wing Hospital, CMIPA, Saint Vincent Medical Group, Southboro Medical Group
  • Members of the Advantage plan must choose a PCP from the network, and they must receive PCP referrals for specialty care.
  • To provide services to a member of the Advantage plan you must be an FCHP Select Care contracted provider.
  • If a member accesses care from a Tier 1 provider, they will pay less.

Members of both options have access to Fallon's Peace of Mind™ Program, $0 wellness, $400 family/$200 individual It Fits! fitness reimbursement, and many other extras.

For more details about The City of Worcester Advantage, view a training deck developed for Fallon providers about this new plan option.