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Direct Care |
The Advantage Plan |
Overview |
Non-tiered limited network plan, which saves you money on your health insurance premium. Offers more than 37,000 providers across Massachusetts, chosen for their medical excellence, cost-efficiency and innovation.
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Same great benefits, but with a larger tiered network of over 59,000 providers across Massachusetts. Providers are tiered based on their accessibility to the community. UMass Memorial Health Care, Saint Vincent Hospital and Reliant Medical Group can all be found in Tier 1. |
Plan year deductible |
No deductible |
Tier 1:
$500 individual/
$1,500 family |
Tier 2:
$750 individual/
$2,250 family |
Out-of-pocket maximum |
$1,000 individual
$3,000 family |
Tier 1:
$2,500 individual
$7,500 family |
Tier 2:
$3,000 individual
$9,000 family |
Routine physical exams |
$0 per visit |
$0 per visit |
PCP office visits |
$20 per visit |
Tier 1:
$20 per visit |
Tier 2:
$30 per visit |
Specialist office visits |
$40 per visit |
Tier 1:
$40 per visit |
Tier 2:
$50 per visit |
Chiropractic care
(12 visits per calendar year) |
$20 per visit |
$30 per visit |
Urgent care/mini clinics |
$20 per visit |
$30 per visit |
Telehealth– 24/7 access to a national network of U.S. Board-Certified doctors to
discuss non-emergency conditions by
phone, mobile app or online |
$20 per visit |
$20 per visit |
Diagnostic services* (Lab, X-ray, etc.) |
Covered in full |
Covered in full after deductible
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Imaging (CAT, PET, MRI scans, nuclear cardiology) (max. of one copayment per day) |
Covered in full |
$50 in a non-hospital setting
$150 in a hospital setting |
Outpatient surgery |
10% coinsurance |
Tier 1:
20% coinsurance
after deductible |
Tier 2:
40% coinsurance
after deductible |
Inpatient surgery |
10% coinsurance |
Tier 1:
20% coinsurance
after deductible |
Tier 2:
40% coinsurance
after deductible |
It Fits! (fitness reimbursement) |
$250 per individual/$500 per family** to use on healthy activities like school and town sports, yoga and dance classes, new cardiovascular home fitness equipment, gym memberships at the gym of your choice, ski lift tickets and much more. **This incentive payment may be considered taxable income. Please consult your tax advisor if you have questions. |