Standard Silver: Community Care Connector High Silver II

Fallon Community Health Plan · 2027 plan year

Silver
Ind. deductible
$2,000
Family deductible
$4,000
Ind. OOP max
$12,000
Family OOP max
$24,000

Compare with other Silver plans in MA

Side by side: deductibles, out-of-pocket limits and copays.

More Fallon Community Health Plan plans in MA

Monthly premiums by age

Rating Area 2

AgeIndividual
Under 15$315
21$496
30$539
40$584
50$729
60$991
64 and over$991

Live premium estimate

$

Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or Illness$30.00

Specialist

BenefitIn-network
Specialist Visit$60.00

Hospital

BenefitIn-network
Emergency Room Services$500.00 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)$1000.00 Copay per Stay after deductible
Outpatient Surgery Physician/Surgical ServicesNo Charge after deductible
Urgent Care Centers or Facilities$60.00

Pharmacy

BenefitIn-network
Specialty Drugs$90.00 Copay after deductible
Generic Drugs$30.00
Non-Preferred Brand Drugs$90.00 Copay after deductible
Preferred Brand Drugs$60.00 Copay after deductible

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services$1000.00 Copay per Stay after deductible
Mental/Behavioral Health Outpatient Services$30.00

Other

BenefitIn-network
Chiropractic Care$30.00
Abortion for Which Public Funding is ProhibitedNo charge
Accidental Dental$30.00
Allergy Testing$60.00
Bariatric Surgery$1000.00 Copay after deductible
Basic Dental Care - Child25.00%
ChemotherapyNo Charge after deductible
Delivery and All Inpatient Services for Maternity Care$1000.00 Copay after deductible
Dental Check-Up for ChildrenNo charge
Diabetes Education$30.00
DialysisNo Charge after deductible
Durable Medical Equipment20.00% Coinsurance after deductible
Emergency Transportation/AmbulanceNo Charge after deductible
Eye Glasses for ChildrenNo charge
Habilitation Services$60.00
Hearing Aids20.00% Coinsurance after deductible
Home Health Care Services$5.00 Copay after deductible
Hospice ServicesNo Charge after deductible
Imaging (CT/PET Scans, MRIs)$350.00 Copay after deductible
Infertility Treatment$250.00 Copay after deductible
Infusion TherapyNo Charge after deductible
Inpatient Physician and Surgical ServicesNo Charge after deductible
Laboratory Outpatient and Professional Services$50.00 Copay after deductible
Major Dental Care - Child50.00%
Nutritional Counseling$30.00
Orthodontia - Child50.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)$30.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)$500.00 Copay after deductible
Outpatient Rehabilitation Services$60.00
Prenatal and Postnatal CareNo charge
Prosthetic Devices20.00% Coinsurance after deductible
RadiationNo Charge after deductible
Reconstructive Surgery$1000.00 Copay after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy$60.00
Rehabilitative Speech Therapy$60.00
Routine Eye Exam (Adult)No charge
Routine Eye Exam for ChildrenNo charge
Routine Foot Care$30.00
Skilled Nursing Facility$1000.00 Copay per Stay after deductible
Substance Abuse Disorder Inpatient Services$1000.00 Copay per Stay after deductible
Substance Abuse Disorder Outpatient Services$30.00
Transplant$1000.00 Copay after deductible
Treatment for Temporomandibular Joint Disorders$60.00
Weight Loss ProgramsNo charge
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging$60.00 Copay after deductible

Service area

This plan covers 93 geographic areas. 93 of them are covered only in part, meaning specific ZIP codes rather than the whole county. The filing does not list which, so confirm with the insurer or on HealthCare.gov before enrolling.

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