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@fallonhealth.org.

Quick look at plans

January 1, 2016 effective dates and beyond

2016

Effective dates of January 1, 2016 and beyond

Copay: affordable options that include inpatient copayments at premium savings
Direct Care network (HMO) Select Care network (HMO)
Copay 500 Copay 500
Copay 1000 Hybrid Copay 1000 Hybrid

Coinsurance: plan designs that provide premium savings by offering coinsurance for inpatient services and diagnostic testing
Direct Care network (HMO) Select Care network (HMO)
Coinsurance 35% Coinsurance 35%

Deductible: plan designs that provide premium savings by offering deductibles for inpatient services and diagnostic testing
Direct Care network (HMO) Select Care network (HMO) Preferred Care network (PPO)
Deductible 1000 Hybrid Deductible 1000 Hybrid
Deductible 1000 Classic Deductible 1000 Classic
Deductible 1500 Classic Deductible 1500 Classic
Deductible 2000 Classic Deductible 2000 Classic
Deductible 2000 Hybrid Deductible 2000 Hybrid
Deductible 2000 Low Deductible 2000 Low Deductible 2000 Low
Bronze Deductible 3000 Bronze Deductible 3000
Deductible 3000 Classic Deductible 3000 Classic

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

Connector plans - individuals and families
Direct Care network (HMO) Select Care network (HMO)
Catastrophic plan
Deductible 2000 Hybrid Deductible 2000 Hybrid
Bronze Deductible 3000 Bronze Deductible 3000
Platinum Connector A Platinum Connector A
Gold Connector A Gold Connector A
Gold Connector B Gold Connector B
Silver Connector A Silver Connector A

Subsidy plans
Community Care
Silver Connector A
Wrap Type I
Wrap Type II
Wrap Type III

2015

Effective dates of July 1, 2015 and beyond

HMO and PPO plans
Copay: affordable options that include inpatient copayments at premium savings
Steward Community Care network Direct Care network Select Care network Preferred Care network
Copay 600 Copay 600 Copay 600 Copay 600
Copay 1000 High Copay 1000 High 15.7 Copay 1000 High 15.7 Copay 1000 High
Copay 1000 High Central Copay 1000 High Central
Copay 1000 Low Copay 1000 Low Copay 1000 Low Copay 1000 Low

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

Deductible: plan designs that provide premium savings by offering deductibles for inpatient services and diagnostic testing
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 1200 Deductible 1200 15.7 Deductible 1200 15.7 Deductible 1200
Deductible 1200 Central Deductible 1200 Central
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
Deductible 3000 Deductible 3000 Deductible 3000 Deductible 3000
Deductible 3000 Classic Deductible 3000 Classic Deductible 3000 Classic Deductible 3000 Classic

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

Connector plans - individuals and families
Steward Community Care network Direct Care network Select Care network
Catastrophic plan Catastrophic plan Catastrophic plan
Deductible 1200 Deductible 1200 Deductible 1200
Deductible 2000 High Deductible 2000 High Deductible 2000 High
Platinum Connector A Platinum Connector A Platinum Connector A
Platinum Connector B Platinum Connector B Platinum Connector B
Gold Connector A Gold Connector A Gold Connector A
Gold Connector B Gold Connector B Gold Connector B
Gold Connector C Gold Connector C Gold Connector C
Silver Connector A Silver Connector A Silver Connector A
QHD Bronze Connector A QHD Bronze Connector A QHD Bronze Connector A

Subsidy plans
Community Care
Silver Connector A
Wrap Type I
Wrap Type II
Wrap Type III

Effective dates of April 1, 2015 and beyond

HMO and PPO plans
Copay: affordable options that include inpatient copayments at premium savings
Steward Community Care network Direct Care network Select Care network Preferred Care network
Copay 600 Copay 600 Copay 600 Copay 600
Copay 1000 High Copay 1000 High Copay 1000 High Copay 1000 High
Copay 1000 High Central Copay 1000 High Central
Copay 1000 Low Copay 1000 Low Copay 1000 Low Copay 1000 Low

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

Deductible: plan designs that provide premium savings by offering deductibles for inpatient services and diagnostic testing
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 1200 Deductible 1200 Deductible 1200 Deductible 1200
Deductible 1200 Central Deductible 1200 Central
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
Deductible 3000 Deductible 3000 Deductible 3000 Deductible 3000
Deductible 3000 Classic Deductible 3000 Classic Deductible 3000 Classic Deductible 3000 Classic

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

Connector plans - SBCs
Steward Community Care network Direct Care network Select Care network

Effective dates of January 1, 2015 and beyond

HMO and PPO plans
Copay: affordable options that include inpatient copayments at premium savings
Steward Community Care network Direct Care network Select Care network Preferred Care network
Copay 600 Copay 600 Copay 600 Copay 600
Copay 1000 High Copay 1000 High Copay 1000 High Copay 1000 High
Copay 1000 Low Copay 1000 Low Copay 1000 Low Copay 1000 Low

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

Deductible: plan designs that provide premium savings by offering deductibles for inpatient services and diagnostic testing
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 1200 Deductible 1200 Deductible 1200 Deductible 1200
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
Deductible 3000 Deductible 3000 Deductible 3000 Deductible 3000
Deductible 3000 Classic Deductible 3000 Classic Deductible 3000 Classic Deductible 3000 Classic

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

Connector plans - SBCs
Steward Community Care network Direct Care network Select Care network

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.