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Health

The City of Fall River offers Health Insurance plans to employees, retirees, and surviving spouses through Blue Cross Blue Shield of Massachusetts.  Participants who wish to obtain more information on the plans can stop by Human Resources or view the summaries of benefits through the links provided below.

 

The City offers active employees and non-Medicare eligible retirees two plans based on their service area. Members residing in in the six New England states are eligible for Network Blue New England Options v.5, which includes a tiered hospital network.

 

Any non-Medicare eligible retirees and their survivors residing outside the New England area will need to enroll in the Blue Care Elect Deductible (PPO) Plan. Active employees who enrolled in Blue Care Elect prior to 7/1/14 are grandfathered in the PPO. Blue Care Elect is significantly more expensive than Network Blue New England with little difference in benefits--it is mainly available for our members that reside outside New England. We recommend all members living in New England enroll in Network Blue New England. You can view the minor differences between the plans here.

 

 

Advantages of the HMO Blue New England Options Deductible v.5 Plan:

 

  • Lower premiums than plan designs with a similar level of benefits (when using Enhanced Benefits Tier providers).
  • Ability for members to control out-of-pocket costs through provider choice.
  • A plan design that's easy to understand and use.

 

How does the HMO Blue New England Options Deductible v.5 Plan work?

 

Hospitals in Massachusetts are grouped into three benefit levels or tiers based on how they scored on cost and quality benchmarks. When members get care, the amount they pay is based on which tier their hospital is in.

 

All ER/urgent care services and out of state (Rhode Island) hospital services will process under the Enhanced benefit tier. Primary Care Providers are not tiered under our plan.

 

  • Enhanced Benefits Tier (most affordable, $) – No deductible applies--Includes Massachusetts hospitals that meet the standards for quality and are low cost relative to the Blue Cross Benchmark.


  • Standard Benefits Tier (premium cost, $$) - $250 per member/$750 per family deductible applies--Includes Massachusetts hospitals that meet the standards for quality and are moderate cost relative to the BCBS benchmark and hospitals that do not meet the standards for quality but are low or moderate cost relative to the BCBS benchmark. Also includes providers without sufficient data for measurement on one or both benchmarks. To ensure members have provider access in certain geographic areas, the Standard Benefits Tier includes some providers whose scores would otherwise put them in the Basic Benefits Tier.


  • Basic Benefits Tier (cost plus, $$$) $250 per member/$750 per family deductible applies, with much higher copays after the deductible is satisfied--Includes Massachusetts hospitals that are high cost relative to the BCBS benchmark that do not meet the standards for quality or are high cost relative to the BCBS benchmark.

  

Please view the list of tiering levels for hospitals in Massachusetts for a better idea of how this might impact you.

 

Benefit Differential - Hospital Facilities Only

High Tech Imaging

Enhanced Tier: $50 copay, not subject to deductible

Standard Tier: $50 copay, deductible applies first

Basic Tier: $100 copay, deductible applies first

 

Outpatient Surgery/ Inpatient Hospital Treatment

Enhanced Tier: $300 copay, not subject to deductible.

Standard Tier: $300 copay, deductible applies first

Basic Tier: $700 copay, deductible applies first

 

 

EFFECTIVE 7/1/2015: DIAGNOSTIC X-RAYS AND LABS ARE NO LONGER SUBJECT TO THE PLAN YEAR DEDUCTIBLE.

 

Blue Cross Blue Shield of Massachusetts offers our employee an array of benefits, such as the Blue Care Line, a 24/7 toll free telephone number which can be accessed by calling 1-888-247-BLUE (2583). A specially trained registered nurse is available to answer your health questions.  BC/BS also offers Weight Loss and Fitness Benefits.  For more information or to download forms, log on to www.bcbsma.com and click on the "My Wellbeing" tab.

 

For specific questions about your plan or any claims please call Blue Cross Member Services at 1-800-782-3675.

 

Please CLICK HERE for a breakdown of tiered prescriptions which apply to both the HMO and PPO.

 

What do the tiers mean?

Tier 1: Generic Medication

Tier 2: Brand Name Medication

Tier 3: Specialty Medication

 

Both plans are eligible for Fitness and Weight Loss Benefits. Please click the corresponding links for more information.

 

Fitness Benefit

Weight Loss Benefit

 

 

Medex 2 with Blue Medicare RX (PDP)

 

Blue Medicare RX is administered by CVS Caremark for the New England Joint Enterprise that Blue Cross Blue Shield of Massachusetts co-manages under the Medicare Contract S2893 and is a prescription drug plan (PDP) that complies with the CMS Medicare rules and regulations for a PDP. Please click here for a list of covered medications.


Medex 2 with Medicare RX (PDP) is a Medicare supplement designed for retired employees age 65 or older (or retired employees that qualify for Medicare Part B before the attainment of age 65.

Frequently asked questions about Medicare and supplemental insurance.

 

Any members on the Blue Medicare RX (PDP) should contact CVS Caremark at 1-800-875-0867 for more information about their medications or to setup a 90-day supply through the mail.

 

 

Open Enrollment

 

The next open enrollment period will be from 4/3/2017 through 5/5/2017 for coverage effective 7/1/2017. All employees, retirees and survivors will be notified about open enrollment beginning the week of 3/27/17.

 

Please feel free to contact the Human Resources department if you have any questions.

 
Other Resources

 

To find out how medical information about you may be used and disclosed and how you can get access to this information please review this Notice of Privacy Practices.

 

Take a look at this Overview of Health Insurance Marketplaces through the Massachusetts Health Connector along with some general information.