Connection supplemental articles and policies - May 2007
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Connection - May 2007 (pdf, 261 KB)
supplemental articles
policies and forms
30th fchp anniversary—spreading the goodwill
FCHP has chosen a different way to celebrate its 30th anniversary this year that we’re calling “pay it forward.”
“We wanted to recognize our 30th anniversary in a very special way,” explains FCHP President and CEO Eric Schultz. “We’re making a donation of $30,000 as part of our charitable giving, but doing it in a different way—by giving our employees the chance to be the kind of everyday hero that exemplifies the FCHP brand.”
Based on an idea popularized in the novel and movie, Pay It Forward, FCHP randomly chose 30 employees to receive $1,000 that they, in turn, will donate to a favorite, local charitable organization. “We’re happy to give some of our employees this opportunity to help FCHP touch many more lives than we’re typically able to do,” Schultz added.
fchp is key player in health care reform
Health care reform is on the fast track in Massachusetts, and Fallon Community Health Plan is keeping pace with this landmark legislation.
FCHP is proud to be one of only four health plans in the state participating in the first wave of reform known as Commonwealth Care. This subsidized insurance program, begun in October, is available to residents who meet certain income requirements (at or below 300% of the federal poverty level). We offer a total of four plans, which all use the FCHP Direct Care network.
Now, FCHP is participating in the second wave of reform, called Commonwealth Choice. This is not a subsidized health insurance program, but rather a program for individuals and small businesses to purchase health insurance on their own. Members and/or employers will pay a monthly premium. Government oversight, as with Commonwealth Care, is through the Commonwealth Health Insurance Connector Authority, known as the “Connector.”
Enrollment began May 1 for a July 1, 2007, effective date—the deadline when all Massachusetts residents are required to have health insurance under the law. The Small Business Service Bureau, named the “Sub-Connector,” is responsible for administration of Commonwealth Choice’s enrollment, customer service and related functions.
several product levels
In addition to “young adult plans” (ages 19 to 26), the Commonwealth Choice products fall into “gold,” “silver” and “bronze” levels of coverage. The three plan levels all offer comprehensive coverage but vary by price and cost sharing.
In giving FCHP its seal of approval to participate in this program, the Connector rated FCHP highly for its premiums and estimated cost sharing as well as plan design and preferred features. All FCHP products include our many value-added features, such as $0 copayments for routine physicals, a 24/7 nurse call line, dental benefits and discounts for the whole family, It Fits!, Oh Baby!, Nurse Connect, Coming Home—and more.
fchp commonwealth choice products
- Gold—Select Care standard (no deductible or out-of-pocket max)
- Silver— Select Care Premium Saver 500 (deductible of $500/$1000 and OOP max of $2000/$4000)
- Silver—Direct Care Premium Saver 500 (deductible of $500/$1000 and OOP max of $2000/$4000)
- Bronze—Direct Care PS 2000 (deductibles of $2000/$4000 and OOP max of $4000/$8000)—proposed with and without Rx coverage)
- Young adult— Direct Care PS 2000 (with 20% coinsurance after $2000/$4000 deductible; OOP max of $5000/$10,000—proposed with and without Rx coverage)
FCHP is committed to getting the word out about health care reform. Over the coming months, you’ll hear more about its progress in this and other FCHP publications. For additional information or inquiries about health care coverage under Commonwealth Choice, please contact FCHP Provider Relations at 1-800-ASK-FCHP, press 4.
medicare advantage enrollment periods
Some of your patients who are members of a Medicare Advantage plan, like Fallon Senior Plan™, may be unclear about when they can join or leave their plan. There are specific rules about this under the Medicare Modernization Act of 2003.
Between January 1 and March 31 of every year, there is an open enrollment period that allows people with Medicare to switch to a plan that is like their current plan.
Otherwise, unless a Medicare beneficiary has a qualifying event (e.g., a change in permanent residence), the next opportunity to enroll in or disenroll from a plan is during the next annual election period. This runs from November 15 through December 31, with an effective date of January 1 of the upcoming year.
If you know Medicare beneficiaries who have questions about when they can enroll or make a change to their Medicare coverage, please have them call Fallon Senior Plan at 1-800-868-5200 (TDD/TTY: 1-877-608-7677), Monday through Friday, from 8 a.m. to 6 p.m.