Adapting to change while continuing to serve
As a nimble organization, Fallon Health is able to respond quickly to change. This has always been an asset, and it’s been an even greater advantage during the COVID-19 pandemic. We adapted quickly to changing circumstances while maintaining full services to clients and members—and we’re continuing to do so.

Our highest priority, as an essential business, is making sure our employees remain safe and able to serve our brokers, clients and members. While we had 90% of our employees make a fast transition to remote work at the start of the pandemic, we are taking a cautious and gradual approach to moving them back to the office. Some staff returned to our Worcester headquarters this fall but the majority continue to work from home. Most staff members have returned to our Programs of All-Inclusive Care for the Elderly in Massachusetts and New York.

To safeguard our workforce, we have robust and stringent safety protocols in place at all Fallon locations, and employees are required to comply whenever they’re on-site. Additionally, all employees, even if they’re working remotely, completed training on social distancing as well as hygiene/mask protocols. Whenever someone plans to enter a Fallon building, they must first complete a health screening questionnaire in a digital health monitoring app.

We continue to closely monitor public health trends related to COVID-19, which are a primary consideration in having more employees return to the office. Fallon will continue to provide our members with comprehensive coverage, to meet and exceed the expectations of our regulators and to help our communities care for people suffering from food insecurity and social isolation.
New for 2021: Streamlined merged market plans
In response to feedback from our clients, we’ve consolidated our merged market offerings into 12 easy-to-understand products for 2021. The simplified plans—for groups with 50 or fewer full-time equivalent employees—all come with the same personal service and attention you’ve come to expect from Fallon.

The plans will be launched on Jan. 1, 2021, and changes will take effect on the group's anniversary date.

For a quote or more information about these plans, please call Kathy Fournier at 1-508-368-9963 or email her at Kathlene.Fournier@fallonhealth.org.
Please welcome …
Brian Cavallo, new Sales VP at UltraBenefits
There’s new sales leadership at UltraBenefits, an affiliated company of Fallon Health. Brian Cavallo, VP for Sales and Account Management, brings an extensive background in helping clients maximize cost savings and tailoring plans to meet their needs.

“Brian’s experience makes him an ideal fit for UltraBenefits,” says Beth Helenius, Vice President for Sales at Fallon. “He’s truly committed to his clients and makes sure they have the right solutions for employees. His approach to his work at UltraBenefits complements our work at Fallon very well.”

In his previous role as Director of Sales for Clark & Lavey Benefit Solutions in Merrimack, New Hampshire, Brian delivered cost-containment strategies for clients that included creating and implementing new plan designs. Earlier in his career, he held director of sales positions at Paradigm Health Plans in Portsmouth, New Hampshire, and Health Services Administrators in Braintree, Massachusetts.

Call Brian at 1-603-702-0000 or email him at Brian.Cavallo@ultrabenefits.com.
Don’t miss out!
Shared Performance Program continues in 2021
Many of our clients have been able to take advantage of a premium credit through our Shared Performance Program. You could benefit from the program as well.

The Shared Performance Program is for employers with 75–99 Fallon subscribers. It offers access to financial and utilization performance data that can help maximize savings on employees’ health care. We offer a 50/50 share of dollars to clients with a medical loss ratio (MLR) under 89% with 5% total opportunity.

Check in with your Sales Executive or Account Manager for more details.
Flu shot more important than ever
The new habits we’ve developed to protect ourselves and others from COVID-19 may have a positive side effect: flu season may be less severe this year.

Wearing masks in public, washing hands frequently and maintaining more physical distance from others can help stem the spread of seasonal flu as well as COVID-19, as recently noted by Robert Redfield, M.D., Director of the Centers for Disease Control and Prevention.

Even with these measures we have all been taking, it is still more important than ever to get a flu vaccine this year. Fewer cases of flu mean less strain on our health care system, which is already burdened as a result of COVID-19.

The flu can also cause serious illness, even for people in good health. Risk of complications increases for those with asthma, COPD (chronic obstructive pulmonary disease), diabetes, heart disease or another chronic illness.

Fallon covers the cost for of getting a flu shot at an in-network pharmacy or the member’s doctor’s office.
Connect online to get open enrollment information
The pandemic has made it more difficult to connect with others in person, but we’ve created online experiences for you to get the information you need about our plans and services. Here’s what’s happening for open enrollment.

For commercial plans, we’re holding virtual open enrollment meetings and health fairs. We’ll host employee presentations via live video or an on-demand recording. These can be customized for specific groups, and attendees can submit real-time questions through the chat feature. And we’ll send out a recording of the presentation afterward.

When Massachusetts guidelines allow—and your clients are ready—we’ll conduct in-person meetings or presentations to smaller-sized groups. In the meantime, please check out our Open enrollment made simple flyer for more information on virtual options.

Plans for retirees
We’re seeing a trend that more people are taking Medicare when it’s available to them during the pandemic. Medicare's Annual Election Period (AEP) continues through Dec. 7.

If you have clients with employees who are nearing retirement or are already eligible for a Medicare plan, you can help them make informed choices with a new resource from Fallon Health. To make the process and various options easier to understand, we’re offering comprehensive Medicare presentations that are available to all via live Zoom meetings or prerecorded presentations.

The presentations give attendees an overview of the federal Medicare program. Visit our website to see the schedule and register. Or watch the prerecorded presentation on YouTube. Our retirement checklist  can also help those who are making plans to retire.
Options and criteria for COVID-19 testing
Fallon covers COVID-19 diagnostic testing, based on CDC and other regulatory guidance, for members who are in one of the following three categories:

  • A health care provider has identified the individual as having COVID-19 related symptoms.

  • A local Board of Health, the Massachusetts Department of Public Health, the Community Tracing Collaborative or a health care provider has determined that the individual has been in close contact with someone confirmed or clinically diagnosed with COVID-19.

  • An individual is admitted to a health care facility, such as a hospital or skilled nursing facility.

Testing solely to meet back-to-work/school COVID-19 testing requirements is not covered, unless it’s deemed medically necessary by a provider.

The state of Massachusetts is running a strategic testing program called Stop the Spread, which is providing free testing in certain cities and towns. Asymptomatic individuals may be tested at these sites, even if they don’t reside in the particular city or town. The Massachusetts Emergency Management Agency’s COVID-19 Test Site Locator provides information on additional testing locations.
Health and wellness
Information you can use and share
You can find health and wellness information for your clients and their employees on our website. A library of health and wellness flyers and kits is also available.
In case you missed it …
Visit our website for previous COVID-19-related messages for brokers. We’ve posted PDF versions of the messages for you there.