Your benefits

FCHP Direct Care and FCHP Select Care - it's your choice!

You have a choice of two FCHP plans - FCHP Direct Care and FCHP Select Care. Both have low copayments, low premiums and easy-to-understand benefits that you won't find anywhere else.

What's the difference between the two plans?

With FCHP Direct Care, our non-tiered limited network plan with over 18,000 providers across the state, you'll save on your health insurance premium. FCHP Select Care has the same great benefits, but with a larger tiered network of over 30,000 providers.

Benefits and copayments

The chart below shows your copayments for some of the most commonly used benefits.

	FCHP Direct Care	FCHP Select Care
Plan overview	Non-tiered limited network plan, which saves you  money on your health insurance premium. Offers 18,000 providers across Massachusetts.	Same great benefits, but with a larger tiered network of over 30,000 providers across Massachusetts.
Deductibles	Calendar year: $250 individual/ $750 family	Calendar year: $250 individual/ $750 family
PCP wellness exams	$0 per visit	$0 per visit
Other PCP office visits	$15 per visit	$20 per visit
Specialist visits	$25 per visit	Tier 1: $25 per visit	Tier 2: $35 per visit	Tier 3: $45 per visit
Prescriptions*	$10/$25/$50	$10/$25/$50
Routine eye exams	$15 per visit	$20 per visit
Mental health and substance abuse	$15 per visit	$20 per visit
Preventive services**	Covered in full	Covered in full
Diagnostic services***	Subject to deductible then covered in full	Subject to deductible then covered in full
Imaging (CAT, PET, MRI scans) (max. of one copayment per day)	$100 copayment (then subject to deductible)	$100 copayment (then subject to deductible)
Chiropractic care (12 visits per calendar year)	$15 per visit	$20 per visit
Emergency services(Copayments for ER services are waived if you are admitted to the hospital)	$100 copayment (then subject to deductible)	$100 copayment (then subject to deductible)
Inpatient hospital	$200 copayment per admission (then subject to deductible)	$250 copayment per admission (then subject to deductible)
Outpatient surgery	$110 copayment (then subject to deductible)	$125 copayment (then subject to deductible)
For more detailed information on benefits and copayments: Download a complete Summary of Benefits (pdf)

Healthy extras

With either FCHP Direct Care or FCHP Select Care, you'll get:

• one of the richest fitness reimbursement in the state ($400 for family, $200 for individual) - now includes new home cardiovascular fitness equipment!
• a 20% discount on CVS/pharmacy-brand health-related products
• and other healthy extras that you won't find with any other plan. 
  Learn more about healthy extras »

* (A generic preferred program is now in place. This means that if you fill a prescription with a brand-name drug when a generic is available, you will be responsible for the drug copayment plus the cost difference between the two drugs.)

** Preventive services are tests, immunizations and services geared to help screen for diseases and improve early detection when symptoms or diagnosis are not present.

*** Diagnostic services are tests, immunizations and services that are intended to diagnose, check the status of, or treat a disease or condition.

FCHP Direct Care provides access to a network that is smaller than FCHP Select Care. In this plan, members have access to network benefits only from the providers in FCHP Direct Care. Please consult the FCHP Direct Care provider directory—a paper copy can be requested by calling our Customer Service Department at 1-866-344-4442—or visit the provider search tool to determine which providers are included in FCHP Direct Care.

FCHP Select Care members have access to network benefits only from the providers in FCHP Select Care, and may pay different levels of copayments, coinsurance and/or deductibles depending on the tier of the provider delivering a covered service or supply. This plan may make changes to a provider’s benefit tier annually on July 1. Please consult the FCHP Select Care provider directory—a paper copy can be requested by calling our Customer Service Department at 1-866-344-4442—or visit the provider search tool to determine which providers are included in FCHP Select Care.