Health Insurance Plan Options

Please be advised that changes to your benefits can only be made during the first 30 days after a life event (birth, death, adoption, marriage, divorce, etc.) or during open enrollment. Newly hired benefit eligible employees have 30 days from their start date to make benefit selections.

for FY20 Health Insurance Rates

Plan Comparison Documents & Pre-Tax Plan Savings Options

Benchmark Plan comparison (FSA/HRA eligible)	High Deductible Health Plan (HSA eligible)
Benchmark Plan Comparison Chart	High Deductible Health Plan Comparison Chart
Flexible Spending Account (FSA) Information	Health Savings Account (HSA) Information
Health Reimbursement Account (HRA) Info	HSA Qualified High Deductible Health Plan Video

*Transition of Care Application - eligible applicants are defined as those who are actively undergoing treatment for a serious, life threatening medical condition whose primary specialist is not covered in the Fallon Network.

**Health Insurance Opt Out Application - to be eligible for the Health Insurance opt out option, employees must have had a Town of Wellesley health insurance plan for two consecutive years prior to opting out.

Benchmark (low deductible) manual open enrollment packet

HSA eligible (high deductible) manual open enrollment packet

Fallon Select Care - www.fchp.org

Fallon Benchmark Plan (FSA/HRA eligible)	Fallon High Deductible Health Plan (HSA eligible)
Fallon Select Comparison Chart	Fallon Select Comparison Chart
Fallon Health Benchmark Plan Summary	Fallon Health High Deductible Plan Summary
Fallon Select Benchmark Plan Summary	Fallon Select HDHP Plan Summary
Fallon Select Participating Hospitals	Fallon Select Participating Hospitals
Fallon ID Card Mobile App	Fallon ID Card Mobile App
CVS Extra Care Card Savings	CVS Extra Care Card Savings
Naturally Well Alternative Health Care	Naturally Well Alternative Health Care
Right Care, Right Place, Right Time	Right Care, Right Place, Right Time
It Fits Reimbursement	It Fits Reimbursement
Fallon SC Benchmark Enrollment Form	Fallon Select HDHP Enrollment Form
CanRx Program - click the Fallon button at the top of the page	Fallon Health Preventative Drug List - medications at co-pay level (deductible does not apply)
Fallon Prescription Formulary	Fallon Prescription Formulary
Good Health Gateway Diabetes Program

Fallon Direct Care - www.fchp.org

Fallon Benchmark Plan (FSA/HRA eligible)	Fallon High Deductible Health Plan (HSA eligible)
Fallon Health Benchmark Plan Summary	Fallon Health High Deductible Plan Summary
Fallon Direct Benchmark Plan Summary	Fallon Direct HDHP Plan Summary
Fallon Direct Participating Hospitals	Fallon Direct Participating Hospitals
Fallon ID Card Mobile App	Fallon ID Card Mobile App
CVS Extra Care Card Savings	CVS Extra Care Card Savings
Naturally Well Alternative Health Care	Naturally Well Alternative Health Care
Right Care, Right Place, Right Time	Right Care, Right Place, Right Time
It Fits Reimbursement	It Fits Reimbursement
Fallon DC Benchmark Enrollment Form	Fallon Direct HDHP Enrollment Form
CanRx Program - click the Fallon button at the top of the page	Fallon Health Preventative Drug List - medications at co-pay level (deductible does not apply)
Fallon Prescription Formulary	Fallon Prescription Formulary
Good Health Gateway Diabetes Program

Harvard Pilgrim Health Care (HPHC HMO) - www.harvardpilgrim.org

HPHC Benchmark Plan (FSA/HRA eligible)	HPHC High Deductible Health Plan (HSA eligible)
HPHC Benchmark Plan Summary	HPHC High Deductible Plan Summary
HPHC Benchmark Enrollment Form	HPHC HDHP Enrollment Form
CanRx Program - click the HP button at the top of the page	HPHC Preventative Drug List - medications at co-pay level (deductible does not apply)
Good Health Gateway Diabetes Program	Good Health Gateway Diabetes Program
HPHC Hospital Tier Listing

Tufts Health Plan - www.tuftshealthplan.com

Tufts Benchmark Plan (FSA/HRA eligible)	Tufts High Deductible Health Plan (HSA eligible)
Tufts Benchmark Plan Summary	Tufts HDHP Plan Summary
Tufts Benchmark Enrollment Form	Tufts HDHP Enrollment Form
CanRx Program - click the Tufts button at the top of the page	Tufts Health Plan Preventative Drug List - medications at co-pay level (deductible does not apply)
Tufts Prescription Formulary	Tufts Prescription Formulary
Good Health Gateway Diabetes Program	Good Health Gateway Diabetes Program

Blue Cross Blue Shield (BCBS) - www.home.bluecrossma.com

BCBS Benchmark Plan (FSA/HRA eligible)	BCBS High Deductible Health Plan (HSA eligible)
BCBS Benchmark Plan Summary	BCBS High Deductible Plan Summary
BCBS Benchmark Enrollment Form	BCBS HDHP Enrollment Form
CanRx Program - click the BCBS button at the top of the page	BCBS Preventative Drug List - medications at co-pay level (deductible does not apply)
	$9 Generic Drug List
Blue Cross Prescription Formulary	Blue Cross Prescription Formulary
Good Health Gateway Diabetes Program	Good Health Gateway Diabetes Program

Harvard Pilgrim PPO (HPHC PPO) - www.harvardpilgrim.org

HPHC PPO Enrollment Form

HPHC PPO Plan Summary