About Fallon Health

NCQA Excellent accreditationFounded in 1977, Fallon Health provides health care services designed to meet the unique and changing needs of all we serve. Fallon is the only health plan in Massachusetts that is both an insurer and provider of care. 

Health insurance products

Our insurance and self-insurance product portfolio includes a variety of group and non-group health plan options (HMO, POS and PPO, as well as Medicaid and Medicare Advantage plans) featuring flexible and innovative benefit designs. In addition, Fallon offers a Program of All-inclusive Care, called Summit ElderCare®, and a Medicare Advantage Special Needs Plan/Senior Care Options program, called NaviCare.

Our uniquely developed provider networks offer high-quality, cost-effective, coordinated care and give our members access to physicians and hospitals throughout Massachusetts and southern New Hampshire. We also offer a broad spectrum of health and wellness services and programs to ensure our members, at every stage of life, remain as healthy and productive as possible.

More about Fallon's plans and products 

Senior Care Services

Our community's aging population is growing in numbers, diversity, and their demand for more customized health care services.

Fallon's strong brand reputation in the senior market and our commitment to offering innovative health insurance solutions makes us uniquely positioned to respond to the needs of the growing and influential senior population. For this purpose, Fallon Health has created a specialized Senior Care Services division.

More about Senior Care Services

Provider of care

As a provider of care, Fallon Health offers Summit ElderCare®, an innovative and completely integrated home- and community-based nursing home alternative for older adults. In addition, Fallon and the VNA Care Network & Hospice jointly own Worcester-based Home Staff, LLC, a home supportive services agency that provides a variety of in-home and health care-related services.

More about Summit ElderCare

Plan Innovations - let Fallon be your partner in health care

Fallon Health's Plan Innovations program provides a range of services, including consulting and program administration, that will help your business create value, reduce costs, mitigate risk and reach your goals.

More about Fallon Health's Plan Innovations

Quality

Our continued commitment to deliver high-quality health care and exceptional customer service has earned Fallon consistent rankings from the National Committee for Quality Assurance (NCQA) as one of the nation’s top health plans. Fallon maintains “Excellent” Accreditation with NCQA for our commercial, Medicare and Medicaid products, and is the only Massachusetts health plan to be accredited across all three product lines.

More about Fallon's quality services

Product and service milestones

  • NaviCare, a Medicare Advantage Special Needs Plan/Senior Care Options program
  • Family Fun program, offering discounts to family- and health-oriented attractions throughout Massachusetts and southern New Hampshire
  • First health plan in Massachusetts to offer health insurance products through eHealthInsurance.com
  • $0 copayments for routine physicals and well-child care (first health plan in the state to offer)
  • It Fits! fitness reimbursement program - Fallon was the first health plan in Massachusetts to reimburse members for school and town sports league fees.
  • Fallon Senior Plan , America’s first Medicare risk product
  • Summit ElderCare, the only PACE (Program of All-inclusive Care for the Elderly) program to be offered by a health plan
  • Qualified high-deductible HMO plans (first in Massachusetts to offer)
  • First federally qualified HMO in central Massachusetts
  • First health plan in Massachusetts to offer a limited network product featuring access to high-quality, cost-efficient doctors and hospitals
  • Care services programs in which nurses interact regularly with members to coordinate their care
  • Worksite wellness programs

* NCQA is a private, non-profit organization dedicated to improving health care quality.

Annual report 

Download Fallon's annual report for 2013