Health insurance solutions for Massachusetts municipalities

Your challenge

My town needs options to control costs. What can Fallon do to help that others can’t? 

Your solution

Fallon Health has an established history of working with cities and towns throughout Massachusetts to help them maximize savings. We provide long-term solutions for both active employees and retirees—in-state and out-of-state. We will work with you to develop a customized plan built to:

  • Drive down health care costs
  • Offer comprehensive benefits and care programs for your employees
  • Comply with Section 21 of the Municipal Health Insurance Reform Act
  • Offer employees access to high-quality health care from the providers they want to see.

Our dedicated municipal sales team will work with your team to determine plan options to maximize savings, develop a competitive benefit structure and price point, and create and deliver member and provider education.

Download our Municipal plan options brochure »

Plan options with Fallon Health

Sample municipal plan design

Benefit Sample cost-sharing
Deductible $300 individual/$600 family
Preventive care $0
PCP office visit $20
Specialist office visit $60
Prescriptions $10/30/65
Emergency room $100 copayment, then subject to deductible
Inpatient hospital $300 copayment, then subject to deductible
Same-day surgery $250 copayment, then subject to deductible (maximum of four copayments per calendar year)
High-tech imaging (CAT, PET, MRI scans) $100 copayment, then subject to deductible
Out-of-pocket maximum $4,000 individual/ $8,000 family

Direct Care

  • Massachusetts’ original limited network plan offers members access to over 39,000 providers.
  • A subset of our larger Select Care network, custom-built around some of the state’s premier physician groups.
  • Delivers up to a 10% premium savings over our broader network.

Select Care

  • Access to a state-wide extensive network of doctors and community-based hospitals throughout Massachusetts and southern New Hampshire.
  • Offer Select Care alongside of Direct Care and save even more.

Fallon Preferred Care

  • A Preferred Provider Organization (PPO) product that has an extensive national and regional network comprised of hundreds of thousands of providers to give your employees the greatest flexibility in where they receive care.

Fallon Medicare Plus Freedom 

  • A secondary payer for Medicare-approved services including Medicare Part A and Part B deductibles and coinsurance
  • Available with and without Part D prescription drug coverage.
  • Accepted nationwide by any provider who accepts Medicare
  • This plan also covers Massachusetts state-mandated services which may or may not be covered by Medicare. 

Fallon Medicare Plus Premier

  • HMO plan that offers more than Original Medicare alone.
  • Provide comprehensive health and wellness benefits with a tailored network of providers.
  • Additional plan options available, like those tailored to retirees who live in Worcester County. Contact us for more information. 

Take the next step

We can help you navigate the changing health insurance landscape and build a plan that works for you.

  • Call your broker or call us at 1-800-333-2535, extension 69434.
  • Fill out our online form to have a Fallon Health representative contact you.
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Take the next step

We'll help you navigate the health care landscape and build a plan that works for you.

Email us ►

1-800-333-2535, ext. 69434.