Benefit summaries and Summaries of Benefits and Coverage (SBC) for our health insurance plans

A variety of low cost plan designs with flexible benefit options and a choice of networks.

To download a benefit summary or SBC for your current plan year, click the "See more" link that corresponds to your plan's effective date. Please note: These documents do not include customizations. These are the standard plan designs. If you need documents for a plan with an earlier effective date, please contact Jen Lavigne at jennifer.lavigne@fchp.org.

2014

For selling business on or after April 1, 2014

Tiered Choice

Options within a tiered provider network
$0 Deductible $0/$2000 Deductible

HMO and PPO plans

Copay: affordable options that include inpatient copayments at premium savings
FCHP Steward Community Care network Direct Care network Select Care network Preferred Care network
Copay 600 Copay 600 Copay 600 Copay 600
Copay 1000 Copay 1000 Copay 1000 Copay 1000

Coinsurance: plan designs that provide premium savings by offering coinsurance for inpatient services and diagnostic testing
FCHP Steward Community Care network Direct Care network Select Care network Preferred Care network
Coinsurance 10% 14.4 Coinsurance 10% 14.4 Coinsurance 10% 14.4 Coinsurance 10% 14.4
Coinsurance 20% Coinsurance 20% Coinsurance 20% Coinsurance 20%
Coinsurance 35% Coinsurance 35% Coinsurance 35% Coinsurance 35%

Deductible: plan designs that provide premium savings by offering deductibles for inpatient services and diagnostic testing
FCHP Steward Community Care network Direct Care network Select Care network Preferred Care network
Deductible 500 14.4 Deductible 500 14.4 Deductible 500 14.4 Deductible 500 14.4
Deductible 1000 14.4 Deductible 1000 14.4 Deductible 1000 14.4 Deductible 1000 14.4
Deductible 1000 Classic Deductible 1000 Classic Deductible 1000 Classic Deductible 1000 Classic
Deductible 1500 14.4 Deductible 1500 14.4 Deductible 1500 14.4 Deductible 1500 14.4
Deductible 1500 Classic 14.4 Deductible 1500 Classic 14.4 Deductible 1500 Classic 14.4 Deductible 1500 Classic 14.4
Deductible 2000 Classic 14.4 Deductible 2000 Classic 14.4 Deductible 2000 Classic 14.4 Deductible 2000 Classic 14.4
Deductible 2000 High Deductible 2000 High Deductible 2000 High Deductible 2000 High
Deductible 2000 Low Deductible 2000 Low Deductible 2000 Low Deductible 2000 Low
Deductible 3000 Deductible 3000 Deductible 3000 Deductible 3000

QHD: qualified high deductible plans that may be partnered with a Health Savings Account (HSA)
FCHP Steward Community Care network Direct Care network Select Care network Preferred Care network
QHD 1500 HSA QHD 1500 HSA QHD 1500 HSA QHD 1500 HSA
QHD 2000 HSA QHD 2000 HSA QHD 2000 HSA QHD 2000 HSA
QHD 3000 HSA QHD 3000 HSA QHD 3000 HSA QHD 3000 HSA

January 1, 2014 effective date

Tiered Choice

Options within a tiered provider network
$0 Deductible $0/$2000 Deductible

HMO and PPO plans

Copay: affordable options that include inpatient copayments at premium savings
FCHP Steward Community Care network Direct Care network Select Care network Preferred Care network
Copay 600 Copay 600 Copay 600 Copay 600
Copay 1000 Copay 1000 Copay 1000 Copay 1000

Coinsurance: plan designs that provide premium savings by offering coinsurance for inpatient services and diagnostic testing
FCHP Steward Community Care network Direct Care network Select Care network Preferred Care network
Coinsurance 10% Coinsurance 10% Coinsurance 10% Coinsurance 10%
Coinsurance 35% Coinsurance 35% Coinsurance 35% Coinsurance 35%

Deductible: plan designs that provide premium savings by offering deductibles for inpatient services and diagnostic testing
FCHP Steward Community Care network Direct Care network Select Care network Preferred Care network
Deductible 500 Deductible 500 Deductible 500 Deductible 500
Deductible 1000 Deductible 1000 Deductible 1000 Deductible 1000
Deductible 1000 Classic Deductible 1000 Classic Deductible 1000 Classic Deductible 1000 Classic
Deductible 1500 Deductible 1500 Deductible 1500 Deductible 1500
Deductible 1500 Classic Deductible 1500 Classic Deductible 1500 Classic Deductible 1500 Classic
Deductible 2000 Classic Deductible 2000 Classic Deductible 2000 Classic Deductible 2000 Classic
Deductible 2000 High Deductible 2000 High Deductible 2000 High Deductible 2000 High
Deductible 2000 Low Deductible 2000 Low Deductible 2000 Low Deductible 2000 Low

QHD: qualified high deductible plans that may be partnered with a Health Savings Account (HSA)
FCHP Steward Community Care network Direct Care network Select Care network Preferred Care network
QHD 1500 HSA QHD 1500 HSA QHD 1500 HSA QHD 1500 HSA
QHD 2000 HSA QHD 2000 HSA QHD 2000 HSA QHD 2000 HSA

2013

April 1, 2013 and beyond

January 1, 2013 and beyond

Direct Care is a plan with a limited provider network. This plan provides access to a network that is smaller than Select Care. In this plan, members have access to network benefits only from the providers in Direct Care. Please visit our Find a Doctor tool or consult the Direct Care provider directory to determine which providers are included in Direct Care. A paper copy can be requested by calling our Customer Service Department at 1-800-868-5200.

Steward Community Care provides access to a network that is smaller than Select Care. In this plan, members have access to network benefits only from the providers in Steward Community Care. Please visit our Find a Doctor tool or consult the Steward Community Care provider directory to determine which providers are included in Steward Community Care. A paper copy can be requested by calling our Customer Service Department at 1-800-868-5200.

Tiered Choice provides access to a network that is smaller than the Select Care provider network, and includes the tiered provider network called Tiered Choice. In this plan, members have access to network benefits only from the providers in Tiered Choice, 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 January 1. Please visit our Find a Doctor tool or consult the Tiered Choice provider directory to determine which providers are included in Tiered Choice. A paper copy can be requested by calling our Customer Service Department at 1-800-868-5200.