Health insurance solutions for Massachusetts municipalities

Your challenge

The Municipal Health Insurance Reform Act opens the door for municipalities to have more flexibility in health insurance options.  

Your solution

Fallon Health has an established history of working with cities and towns to create health plans that meet their unique needs. With options for active employees and retirees—both in-state and out-of-state—we'll work with you to develop a customized plan built to:

  • Drive down health care costs
  • Offer comprehensive benefits and care programs for your employees
  • Comply with Section 21 of the Municipal Health Insurance Reform Act
  • Offer employees access to high-quality health care from the providers they want to see.

Our qualified and experienced experts will collaborate with your team to determine plan options to maximize savings, develop a competitive benefit structure and price point, and create and deliver member and provider education.

Plan options with Fallon Health

Sample municipal plan design

Benefit Sample cost-sharing
Deductible $250 individual/$500 family
Preventive care $0
PCP office visit $20
Specialist office visit $35
Prescriptions $10/25/50
Emergency room $100 copayment, then subject to deductible
Inpatient hospital $300 copayment, then subject to deductible(maximum of four copayments per calendar year)
Same-day surgery $150 copayment, then subject to deductible (maximum of four copayments per calendar year)
High-tech imaging (CAT, PET, MRI scans) $100 copayment, then subject to deductible
Out-of-pocket maximum $2,000 individual/ $4,000 family

Direct Care

  • Massachusetts’ original limited network plan offers members access to over 30,000 providers.
  • A subset of our larger Select Care network, custom-built around some of the state’s premier physician groups.
  • Delivers up to a 13% premium savings over our broader network.

Select Care

  • Access to a state-wide extensive network of doctors and community-based hospitals throughout Massachusetts and southern New Hampshire.
  • Offer Select Care alongside of Direct Care and save even more.

Preferred Care

  • A Preferred Provider Organization (PPO) product that has an extensive national and regional network comprised of hundreds of thousands of providers to give your employees the greatest flexibility in where they receive care.

Senior Plan

  • HMO and PPO plans offer more than Medicare alone.
  • Provide comprehensive health and wellness benefits with a tailored network of providers.

Fallon Companion Care 

  • Accepted nationwide by any provider who accepts Medicare.
  • Offers secondary coverage for any service covered by Medicare Part A or B and pays your annual deductible.
  • This plan also covers Massachusetts state-mandated services which may or may not be covered by Medicare.

Take the next step

We can help you navigate the changing health insurance landscape and build a plan that works for you.

  • Call your broker or call us at 1-800-333-2535, extension 69434.
  • Fill out our online form to have a Fallon Health respresentative contact you.
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Take the next step

We'll help you navigate the health care landscape and build a plan that works for you.

Email us ►

1-800-333-2535, ext. 69434.

Why Fallon Health?

Fallon Health's Plan Innovations leverages our 35+ year history in creating successful health care solutions across all health care markets. From pioneering the first Medicare Risk demonstration plan in 1980 and the first Medicare-Medicaid plan to being the first health plan in the country to build and operate a PACE program in 1995 to implementing unique, customized plan options for our state’s largest employers, Fallon remains a health care leader.

Materials from 6/20/12 seminar