Prospective members who are shopping for a plan
To download a benefit summary, Summary of Benefits and Coverage (SBC) or Schedule of Benefits, click the "See more" link that corresponds to your plan's effective date below. For Evidence of Coverage (EOC) documents, click the links in the "Evidence of Coverage" box to the right.

Current members
You can view and download your specific plan documents by logging in to myFallon.

For individuals who get insurance through a large employer*
The plan documents below are only a sample. Benefits, copayments, coinsurance and deductible amounts can vary by each employer.

  • If you are shopping for a new plan, please check with your HR/Benefits Administrator for your employer’s actual plan documents.
  • If you are a current Fallon member, you can log in to myFallon to see your current plan documents.

Download the Glossary of Health Coverage and Medical Terms (pdf)

* A large employer is defined as an employer with more than 50 full-time equivalent employees (total full-time employees plus FTEs represented by aggregating the hours worked by part-time employees). For further details, see Massachusetts Division of Insurance Bulletin 2016-09.

2019

Effective dates of January 1, 2019 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 1250 Hybrid Deductible 1250 Hybrid
Deductible 2000 Hybrid Deductible 2000 Hybrid
Deductible 2500 Hybrid Deductible 2500 Hybrid
Deductible 3000 Hybrid Deductible 3000 Hybrid
Deductible 2000 Low Deductible 2000 Low Deductible 2000 Low
Deductible 1000 Classic Deductible 1000 Classic
Deductible 1500 Classic Deductible 1500 Classic
Deductible 2000 Classic Deductible 2000 Classic
Deductible 3000 Classic Deductible 3000 Classic
Bronze Deductible 3000 Bronze Deductible 3000

 

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) Community Care network (HMO)
Platinum Connector Platinum Connector  
Gold Connector High Gold Connector High  
Gold Connector Low    
Deductible 2000 Hybrid Deductible 2000 Hybrid  
Silver Connector II Silver Connector II Silver Connector II
Bronze Connector Bronze Connector  
Catastrophic  

Connector plans - small group
Direct Care network (HMO) Select Care network (HMO) Community Care network (HMO) Preferred Care network(PPO)
Platinum Connector Platinum Connector    
Gold Connector High Gold Connector High    
Gold Connector Low      
Deductible 2000 Hybrid Deductible 2000 Hybrid    
Silver Connector Silver Connector Silver Connector  
Silver Connector Low HSA Silver Connector Low HSA    
Bronze Connector Bronze Connector    
      Deductible 2000 Low

ConnectorCare (subsidy) plans
Community Care network (HMO)
Wrap Type I
Wrap Type II
Wrap Type III

2018

Effective dates of January 1, 2018 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 Classic Deductible 1000 Classic
Deductible 1200 Hybrid Deductible 1200 Hybrid
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
Silver Connector Silver Connector
Silver Connector II Silver Connector II
Bronze Connector Bronze Connector
Gold Connector B Gold Connector B
Platinum Connector Platinum Connector

Subsidy plans
Community Care
Silver Coinsurance 35%
Silver Coinsurance 35% II
Wrap Type I
Wrap Type II
Wrap Type III

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.

 

Evidence of Coverage (EOC) documents

Rate increase explanations

Find a doctor

Are you looking for a doctor, hospital, pharmacy, or other providers?

Find a doctor online