Plan Information

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800-868-5200 (TRS 711)

Fallon Health

Offers ConnectorCare Plans

“Founded in 1977, Fallon Health provides health care services designed to meet the unique and changing needs of all we serve. Fallon is the only health plan in Massachusetts that is both an insurer and provider of care.

Our insurance and self-insurance product portfolio includes a variety of group and non-group health plan options (HMO, POS and PPO, as well as Medicaid and Medicare Advantage plans) featuring flexible and innovative benefit designs. In addition, Fallon offers a Program of All-inclusive Care, called Summit ElderCare®, and a Medicare Advantage Special Needs Plan/Senior Care Options program, called NaviCare.

Our uniquely developed provider networks offer high-quality, cost-effective, coordinated care and give our members access to physicians and hospitals throughout Massachusetts and southern New Hampshire. We also offer a broad spectrum of health and wellness services and programs to ensure our members, at every stage of life, remain as healthy and productive as possible.”

From “About Fallon Health'”

2019 Plan Information

NCQA Accreditation Star Ratings

Overall
3 out of 4 stars
This is the health insurer’s accreditation score from the National Committee for Quality Assurance (NCQA). NCQA evaluates the insurer’s quality measures and ongoing improvement.
Access and Service
3 out of 4 stars
NCQA evaluates how well the insurer provides access to needed care and with good customer service. To evaluate these activities, NCQA reviews the insurer’s appeals and denials, interviews the insurer’s staff and grades the results from consumer surveys.
Qualified Providers
3 out of 4 stars
NCQA evaluates the insurer’s efforts to confirm that each doctor is licensed and trained to practice medicine and that the health plan’s members are happy with their doctors. To evaluate these activities, NCQA uses records of doctors’ credentials, interviews the insurer’s staff, and grades the results from consumer surveys.
Staying Healthy
3 out of 4 stars
NCQA evaluates the insurer’s activities that help people maintain good health and avoid illness. To evaluate these activities, NCQA reviews the insurer’s records, grades independently verified clinical data and reviews materials sent to members.
Getting Better
3 out of 4 stars
NCQA evaluates health plan activities that help people recover from illness. To evaluate these activities, NCQA reviews the insurer’s records and interviews the insurer’s staff.
Living with Illness
3 out of 4 stars
NCQA evaluates health plan activities that help people manage chronic illness. NCQA grades independently verified clinical data and interviews the insurer’s staff.

About these ratings
NCQA Logo

The National Committee for Quality Assurance (NCQA) is a private non-profit dedicated to improving health care quality. NCQA accredits and certifies health care organizations and recognizes physicians in key clinical areas. Visit www.ncqa.org to learn more.

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