Broker FAQ
To better serve our Fallon Community Health Plan brokers, we've compiled some of the most frequently asked questions below.
Don't see your question listed here? Let us know and we'll work on adding it to our list!
On this page:
Question:
What's the difference between FCHP Select Care and FCHP Direct Care?
Answer:
FCHP Direct Care is a subset of the FCHP Select Care network, custom -uilt around some of the state’s premier physician groups and hospitals, giving you access to quality providers at a significantly lower premium cost.
The FCHP Select Care product offers a much broader choice of providers to help us better meet the needs of employers who have personnel throughout western, central and eastern Massachusetts. Members can choose from thousands of providers and 57contracted hospitals throughout the state, including the Bay State Health system, Anna Jaques Hospital, Emerson Hospital, Fallon Clinic, Greater Milford Health Alliance, Lawrence General Hospital, Merrimack Valley Hospital, Mount Auburn Cambridge IPA, Nashoba Valley Medical Center Northeast Medical Associates, UMass Memorial Health Care and Winchester Hospital.
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Question:
How do I find out the name of my assigned sales executive?
Answer:
Contact Tina Aubin, Sales Coordinator, at 508-368-9986.
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Question:
What is the process for submitting a quote request?
Answer:
You may simply fax a census to your assigned sales executive or to Tina Aubin at 508-368-9565 or e-mail her at tina.aubin@fchp.org.
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Question:
When can I expect to receive a rate after submitting a quote request?
Answer:
Rates are typically forwarded three to five days following our receipt of a quote request.
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Question:
What factors go into FCHP's rating methodology?
Answer:
Fallon Community Health Plan utilizes the following factors for pricing purposes:
For groups with fewer than 51 lives:
- Subscriber age
- Region (based on employer ZIP code)
- Family status
For groups with more than 51 lives:
- Subscriber age
- Subscriber gender
- Subscriber ZIP code or subscriber health care option*
- Employer industry
- Family mix
* ZIP codes are used for pricing prospective business; Health care options (based on member-level primary care physician) are used for renewal pricing.
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Question:
Are rates affected by broker involvement?
Answer:
Broker commissions are part of FCHP's overall administrative cost and rates are not loaded or discounted based on the involvement of a broker.
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Question:
What are FCHP's participation guidelines?
Answer:
Fallon Community Health Plan prefers that all employees enrolled by the Employer into the Plan are full-time employees working 30 hours or more per week (including any owners of the business) or part-time employees working at least 20 hours per week and receiving an employer contribution (of at least 50% of the premium) toward the health insurance coverage.
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Question:
How many providers are in the FCHP network?
Answer:
Our provider network includes more than 13,000 providers and 40 hospitals throughout our service area. We continually add providers so that your clients can offer their employees greater choice.
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Question:
Are Boston hospitals part of FCHP's network?
Answer:
The use of community hospitals is encouraged, but not restricted. FCHP Direct Care and FCHP Select Care include our Peace of Mind Program™ that allows members to receive care at certain Boston medical facilities at no additional charge. This feature is designed to encourage an informed dialogue between the patient and the primary care provider, as they work together to decide where appropriate care should be given. It's ultimately the member's choice to decide to use one of these facilities. FCHP will continue to manage the care for HMO members seeking to use this program. Members enrolled through FCHP Flex Care Select or FCHP Flex Care Direct can access Boston-based hospitals by utilizing the out-of-network part of the plan.
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Question:
What's the difference between Fallon Clinic and FCHP?
Answer:
Fallon Community Health Plan is a health maintenance organization, while Fallon Clinic is a physician group practice.
FCHP is a nonprofit, mixed-model HMO that provides health insurance coverage for its members through a network of professionals and hospitals. FCHP offers a range of health plan options to meet the needs of individuals, families and employers of all sizes. We ensure that our members have access to quality care and services through hundreds of private practice physicians in Massachusetts, as well as to Fallon Clinic, FCHP's founding medical group.
Fallon Clinic is a multispecialty group practice, which began in 1929, where specialists and primary care providers work closely together to provide high-quality health care for the community. Over the years, Fallon Clinic has expanded their practice and retained physicians from some of the best medical schools in the country to provide patients with high-quality care using advanced technology.
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Question:
What are FCHP's service areas?
Answer:
The FCHP Direct Care and FCHP Flex Care Direct service area includes providers in all of Worcester County, and parts of Middlesex, Hampden and Norfolk Counties. The FCHP Select Care and FCHP Flex Care Select service area includes providers in Bristol, Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk and Worcester Counties. The Fallon Senior Plan™ service area includes Worcester County and portions of Franklin, Hampden, Hampshire, Middlesex and Norfolk Counties.
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Question:
Does FCHP cover out-of-state employees?
Answer:
FCHP has several plans that will cover out-of-state employees. Fallon Preferred Care is a preferred provider organization (PPO) which has a network of nearly 450,000 providers and over 4000 health care facilities nationwide through Private Healthcare Systems (PHCS). Flex Care Direct and Flex Care Select are point-of-service (POS) plans which contain out-of-network benefits in the form of coinsurance.
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Question:
Does FCHP offer a qualified high-deductible health plan that's compatible with a health savings account?
Answer:
Yes, FCHP has a full array of qualified high-deductible health plans available through FCHP Care Choice.
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