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, 2021 effective dates and beyond

January 1, 2020 effective dates and beyond

2022

Effective dates of January 1, 2022 and beyond

Connector plans - individuals and families
Community Care network (HMO)
Connector Platinum
Connector High Gold
Connector Low Gold
Connector High Silver II
Connector Bronze #1

Connector plans - small group
Community Care network (HMO)
Connector Platinum
Connector High Gold
Connector Low Gold
Connector High Silver
Connector Low Silver HSA
Connector Bronze #1

ConnectorCare (subsidy) plans
Community Care network (HMO)
ConnectorCare I
ConnectorCare II
ConnectorCare III

2021

Effective dates of January 1, 2021 and beyond

Copay: affordable options that include inpatient copayments at premium savings
Direct Care network (HMO) Select Care network (HMO)
Copay 1000 Copay 1000

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 1250 Deductible 1250
Deductible 2000 Low Deductible 2000 Low Deductible 2000 Low
Deductible 2000 High Deductible 2000 High
Deductible 3000 High Deductible 3000 High
Deductible 5000 Low Deductible 5000 Low
Bronze Deductible 3000 Bronze Deductible 3000
Bronze Deductible 5000 Bronze Deductible 5000

 

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) Community Care network (HMO)
Connector Platinum Connector Platinum  
Connector High Gold Connector High Gold  
Connector Low Gold Connector Low Gold  
Connector High Silver Connector II Connector High Silver Connector II Connector High Silver Connector II
Connector Bronze #1 Connector Bronze #1  
Connector Catastrophic  

Connector plans - small group
Direct Care network (HMO) Select Care network (HMO) Community Care network (HMO) Preferred Care network(PPO)
Connector Platinum Connector Platinum    
Connector High Gold Connector High Gold    
Connector Low Gold Connector Low Gold    
Connector Silver Connector Silver Connector Silver  
Connector Low Silver HSA Connector Low Silver HSA    
Connector Bronze #1 Connector Bronze #1    
      Deductible 2000 Low

ConnectorCare (subsidy) plans
Community Care network (HMO)
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.