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, 2021 effective dates and beyond
January 1, 2020 effective dates and beyond
2022
Effective dates of January 1, 2022 and beyond
Connector plans - individuals and families
Community Care network (HMO) |
Connector Platinum
|
Connector High Gold
|
Connector Low Gold
|
Connector High Silver II
|
Connector Bronze #1
|
Connector plans - small group
Community Care network (HMO) |
Connector Platinum
|
Connector High Gold
|
Connector Low Gold
|
Connector High Silver
|
Connector Low Silver HSA
|
Connector Bronze #1
|
ConnectorCare (subsidy) plans
Community Care network (HMO) |
ConnectorCare I
|
ConnectorCare II
|
ConnectorCare III
|
2021
Effective dates of January 1, 2021 and beyond
Copay: affordable options that include inpatient copayments at premium savings |
Direct Care network (HMO) |
Select Care network (HMO) |
Copay 1000
|
Copay 1000
|
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
|
Deductible 1250
|
|
Deductible 2000 Low
|
Deductible 2000 Low
|
Deductible 2000 Low
|
Deductible 2000 High
|
Deductible 2000 High
|
|
Deductible 3000 High
|
Deductible 3000 High
|
|
Deductible 5000 Low
|
Deductible 5000 Low
|
|
Bronze Deductible 3000
|
Bronze Deductible 3000
|
|
Bronze Deductible 5000
|
Bronze Deductible 5000
|
|
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) |
Connector Platinum
|
Connector Platinum
|
|
Connector High Gold
|
Connector High Gold
|
|
Connector Low Gold
|
Connector Low Gold
|
|
Connector High Silver Connector II
|
Connector High Silver Connector II
|
Connector High Silver Connector II
|
Connector Bronze #1
|
Connector Bronze #1
|
|
Connector Catastrophic
|
|
|
Connector plans - small group
Direct Care network (HMO) |
Select Care network (HMO) |
Community Care network (HMO) |
Preferred Care network(PPO) |
Connector Platinum
|
Connector Platinum
|
|
|
Connector High Gold
|
Connector High Gold
|
|
|
Connector Low Gold
|
Connector Low Gold
|
|
|
Connector Silver
|
Connector Silver
|
Connector Silver
|
|
Connector Low Silver HSA
|
Connector Low Silver HSA
| |
|
Connector Bronze #1
|
Connector Bronze #1
|
|
|
|
|
|
Deductible 2000 Low
|
ConnectorCare (subsidy) plans
Community Care network (HMO) |
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.