Commonwealth of Massachusetts Group Insurance Commission Booklet
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Direct Care With Direct Care, a limited network product, you have access to local doctors and community hospitals you know and trust. These providers are carefully chosen for their medical excellence, patient access and innovation. There are more than 38,000 participating providers in the Direct Care network. n Direct Care service area n Participating hospitals Specialist tiering for Direct Care Direct Care members have access to high-quality, cost-efficient specialists, who are tiered. For more information on specialist tiering, see the enclosed Benefit Summary. Direct Care provides guaranteed access for a second opinion and treatment for specialty services at several Boston teaching hospitals with the Peace of Mind ProgramTM. All specialist visits will have a $75 copayment. Get more for less with Direct Care The medical centers included in the Peace of Mind Program are: • Find your doctor. Visit fallonhealth.org/gic. Under “Tools • Beth Israel Deaconess Medical Center for members,” click “Find a doctor.” • Boston Children’s Hospital • Receive care from doctors and hospitals close to home and work. • Brigham and Women’s Hospital • Save with $0 wellness. (e.g.; routine • Dana-Farber Cancer Institute physical exams, annual gynecological • Massachusetts General Hospital exams and well child visits) • Receive worldwide emergency coverage. To learn more about the Peace of Mind Program, see page 10. • Get paid for participating in healthy activities. It Fits!—one of the state’s richest fitness benefits—reimburses up to $200 per individual and $400 per family! 8 | 1-866-344-4442 • fallonhealth.org/gic Direct Care participating hospitals Addison Gilbert Hospital – Gloucester MetroWest Medical Center – Framingham Athol Hospital – Athol Milford Regional Medical Center – Milford Beth Israel Deaconess Hospital – Milton Mount Auburn Hospital – Cambridge Beth Israel Deaconess Hospital – Plymouth New England Baptist Hospital – Boston Beverly Hospital – Beverly Newton-Wellesley Hospital – Newton Brigham and Women’s Faulkner Hospital – Boston Saint Luke’s Hospital – New Bedford Charlton Memorial Hospital – Fall River Saint Vincent Hospital – Worcester Emerson Hospital – Concord Signature Healthcare Brockton Hospital – Brockton Harrington HealthCare at Hubbard – Webster South Shore Hospital – South Weymouth Harrington Hospital – Southbridge Tobey Hospital – Wareham Heywood Hospital – Gardner Tufts Medical Center – Boston Lahey Hospital and Medical Center – Burlington UMass Memorial HealthAlliance – Clinton Hospital, Clinton Lahey Medical Center – Peabody UMass Memorial HealthAlliance – Clinton Hospital, Lawrence General Hospital – Lawrence Burbank Campus, Fitchburg Lawrence Memorial Hospital – Medford UMass Memorial HealthAlliance – Clinton Hospital, Lowell General Hospital, Main Campus – Lowell Leominster Campus, Leominster Massachusetts Eye and Ear – Boston UMass Memorial – Marlborough Hospital, Marlborough MelroseWakefield Hospital – Melrose Winchester Hospital – Winchester Direct Care physician groups Acton Medical Associates Merrimack Health Network Allied Pediatrics of Greater Brockton* Merrimack Valley IPA* Brockton Area Primary Care, LLC * Metrowest Quality Care Alliance* Brockton Hospital Milton Primary Care, LCO* Cape Ann Medical Center Mount Auburn Cambridge IPA Cape Ann Pediatrics Newton-Wellesley PHO Charles River Medical Associates Northeast PHO Community Health Connections Pediatric Associates of Brockton, Inc.* Greater Lawrence Family Health Center Pentucket Medical Associates Hallmark Health Plymouth Bay Primary Care, LLC* Harbor Medical Associates Primary Care Medical Associates* Harrington PHO Physician Hospital Organization Reliant Medical Group HealthCare South, P.C.* Saint Vincent Medical Group HealthFirst Family Center (Fall River) Signature Medical Group Heywood PHO Southboro Medical Group Highland Healthcare Associates IPA Southcoast Physicians Network Lahey Clinic Physicians South Shore Health Lawrence General IPA Southwest Boston Primary Care Lowell General PHO Steward CMIPA Lower Merrimack Valley PHO Tufts Medical Center Physicians Organization, Inc.* Mass Bay Medical Associates, LLC* Woburn and North Andover Pediatric, LLC* *A New England Quality Care Alliance Group 1-866-344-4442 • fallonhealth.org/gic | 9.