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Getting care during a disaster

During an emergency or disaster, Fallon Health will make sure you have access to your health plan benefits. The rules for getting care may change for a short time in areas where one of these has happened:

• The President has declared an emergency or disaster.
• The governor has declared an emergency or disaster.
• The Secretary of the Department Of Health And Human Services has declared a public health emergency.

Seeing your doctors or other providers in a disaster or emergency

During a qualified disaster or emergency:

• You may be able to see certain doctors or go to certain hospitals that accept Medicare patients, even if the doctor or hospital isn't in your plan's network and your health care need isn't an emergency.
• You may be able to get care from out-of-network providers at the in-network cost-sharing amounts
• You may not need a referral or prior authorization for out-of-network services.

Filling your prescriptions in a disaster or emergency (for members with Part D prescription drug coverage

If you can't reasonably get to a network pharmacy, you may be able to use an out-of-network pharmacy to fill your prescriptions. For refills, we will remove restrictions that stop you from getting refills too soon and also cover the maximum supply of your refill if you ask for it.

When you buy your drugs at an out-of-network pharmacy, you may have to pay full cost for the drugs at the time you fill your prescriptions. If you pay full cost for the drugs, save your receipts so you can ask your plan if it'll refund you for your costs (Note: You won't get a refund for the out-of-network cost-sharing amount). Ask your plan how to submit your claim.

For more information

In the case of a disaster or emergency, we’ll keep you informed about how to receive covered care and prescription drugs. For more information, call 1-800-325-5669 (TRS 711)
8 a.m.–8 p.m., Monday–Friday. (Oct. 1–March 31, seven days a week.)