Fallon Health strategic business change

In alignment with our mission and our unique capabilities, Fallon Health will begin primarily focusing its resources on supporting the health care needs of individuals enrolled in government-sponsored programs. Starting April 1, 2021, we will discontinue selling a significant portion of commercial health insurance coverage to employer groups and some individuals. Products affected are:

  • Direct Care
  • Select Care
  • Steward Community Care
  • Preferred Care
  • Fallon Medicare Plus Freedom (Group Medicare Supplement plan)

Fallon will be notifying employers and members by mail at least 90 days before they will be impacted.

Frequently asked questions - members

Q. I am a member. Am I losing my health care coverage?

If you are a member of one of the products listed above, your current plan coverage through Fallon may end upon your plan’s next anniversary date. The anniversary date is the date each year when most major changes to your health plan take effect. The anniversary date is usually preceded by an open enrollment period. If you don’t know when your plan’s anniversary date is, please contact your employer. You will receive a notification from Fallon at least 90 days in advance of the date you will be impacted. Your employer will also be able to let you know when your coverage will be impacted.

Fallon Health is continuing to offer current health care coverage and services to individuals enrolled in the following products:

  • Community Care
  • Fallon 365 Care
  • Berkshire Fallon Health Collaborative
  • Wellforce Care Plan   
  • NaviCare®
  • Summit ElderCare®
  • Fallon Medicare Plus™ Medicare Advantage (group and individual)
  • Fallon Medicare Plus™ Medicare Supplement (individual)

In you are a member of one of the above products, your current health insurance plan is not affected by this change.

Q. I have Community Care, but I don’t receive government subsidies to pay my premium/cost-sharing. Am I losing my coverage?

No. Community Care is not impacted by this change.

Q. Has my employer been notified?

Fallon is notifying employers of this change. Fallon will work with you and your employer to ensure a smooth transition to your next health care coverage carrier.

Q. What can I expect from Fallon until my plan is discontinued?

Your coverage will remain as is until your plan is discontinued. Upon your open enrollment you will need to select a new plan. We will be doing everything possible to minimize the amount of disruption this change may create for you.

Q. I get my coverage through the Connector. Am I losing my coverage?

Nothing is happening immediately. Your current plan coverage (with Direct Care, Select Care and Preferred Care) will remain in effect until the end of this plan year, which is December 31, 2021. You will receive more information about available options at that time. Fallon will only continue to offer its Community Care product on the Connector to individuals.

Q. I get my coverage through a co-op/directly from Fallon as individual coverage. Am I losing my coverage?

Nothing is happening immediately. Your current plan coverage will remain in effect until your plan anniversary date. The anniversary date is the date each year when most major changes to your health plan take effect. The anniversary date is usually preceded by an open enrollment period. If you don’t know when your plan’s anniversary date is, please contact your employer or intermediary. You will receive a notification from Fallon well in advance of the date you will be impacted.

Q. My open enrollment period is happening now, and Fallon is still being offered to me. Do I need to make a change?

No. If your employer includes Fallon as an option for you, you do not need to make any changes if you are currently a Fallon member.

Q. I am a member of Fallon Medicare Plus Freedom. Am I losing my health care coverage?

The Fallon Medicare Plus Freedom plan you receive through your employer will no longer be offered starting January 1, 2022. That means that your current plan will end at the end of this plan year on December 31, 2021.

Frequently asked questions - employers

Q. When will I be impacted by this change?

If you are a member of one of the products listed above, your current plan coverage through Fallon may end upon your plan’s next anniversary date. You will receive a notification from Fallon at least 90 days in advance of the date you will be impacted. This process is anticipated to take 12-18 months in total. Fallon will be doing everything possible to minimize the amount of disruption this change will create for our clients and members.

Q. What can I expect from Fallon until my plan is discontinued?

Fallon Health will provide notification in advance of the discontinuation. Until that time, you will continue to receive the same client service you have been receiving and members will continue to receive the same. We will be doing everything possible to minimize the amount of disruption this change may create for you and your employees.

Q. Have my employees been notified?

Fallon is required to notify members of this plan termination. However, we are notifying employers first and members immediately after.

Q. Will small group HMO plans receive a renewal in 2021?

  • If your anniversary date is in April, May or June, yes. If you choose to renew—or you have already renewed—with Fallon, your plan(s) will be in place until your 2022 anniversary date. At that time, your plan(s) will be discontinued.
  • If your anniversary date is in July or beyond, no. Your plan will be discontinued upon your anniversary date, and you will not receive a renewal.

Q. Will small group PPO plans receive a renewal in 2021?

  • If your anniversary date is in April, May, June, July, August or September, yes. If you choose to renew with Fallon, your plan(s) will be in place until your 2022 anniversary date. At that time, your plan(s) will be discontinued.
  • If your anniversary date is in October or beyond, no. Your plan will be discontinued upon your anniversary date, and you will not receive a renewal.

Q. Will large group HMO/PPO plans receive a renewal in 2021?

  • If your anniversary date is in April, May, June, July, August or September, yes. If you choose to renew with Fallon, your plan(s) will be in place until your 2022 anniversary date. At that time, your plan(s) will be discontinued.
  • If your anniversary date is in October or beyond, no. Your plan will be discontinued upon your anniversary date, and you will not receive a renewal.

Frequently asked questions - general

Q. Why is Fallon Health making this change?

Fallon Health is embarking on a new strategy to become a leading health care services organization committed to programs like Medicare and Medicaid. As a result, Fallon will discontinue offering many of our commercial plans.

Q. When is this change happening?

This process is anticipated to take 12-18 months in total. Depending on the specific type of Fallon plan an employer or individual has, plans will begin to be discontinued on or after July 1, 2021. During this time, Fallon will be doing everything possible to minimize the amount of disruption this change will create for our members.

Q. Is Fallon going out of business?

No. In keeping with our mission and unique capabilities, Fallon has made a decision to begin primarily focusing on providing health insurance coverage, care and services to individuals enrolled in Medicare and Medicaid programs.

Q. Fallon has always been very active in the community. Will that change?

Fallon will continue to remain very active in all of our communities through grants, employee volunteerism and sponsorships.

Information for brokers

We will continue to service our existing business until their plan discontinuation dates. However, we are no longer offering quotes for new business for the following products:

  • Direct Care
  • Select Care
  • Steward Community Care
  • Preferred Care
  • Fallon Medicare Plus Freedom (Group Medicare Supplement plan)

If you have any questions, please call us at 1-877-502-1200 or email us at salesops@fallonhealth.org.

Q. Will small group HMO plans receive a renewal in 2021?

  • If your anniversary date is in April, May or June, yes. If you choose to renew—or you have already renewed—with Fallon, your plan(s) will be in place until your 2022 anniversary date. At that time, your plan(s) will be discontinued.
  • If your anniversary date is in July or beyond, no. Your plan will be discontinued upon your anniversary date, and you will not receive a renewal.

Q. Will small group PPO plans receive a renewal in 2021?

  • If your anniversary date is in April, May, June, July, August or September, yes. If you choose to renew with Fallon, your plan(s) will be in place until your 2022 anniversary date. At that time, your plan(s) will be discontinued.
  • If your anniversary date is in October or beyond, no. Your plan will be discontinued upon your anniversary date, and you will not receive a renewal.

Q. Will large group HMO/PPO plans receive a renewal in 2021?

  • If your anniversary date is in April, May, June, July, August or September, yes. If you choose to renew with Fallon, your plan(s) will be in place until your 2022 anniversary date. At that time, your plan(s) will be discontinued.
  • If your anniversary date is in October or beyond, no. Your plan will be discontinued upon your anniversary date, and you will not receive a renewal.