The power of connection

For me, one of the major takeaways from living with the pandemic these past two years has been this: connection is key. Whether it’s online or in-person (safely), maintaining contact with family, friends and colleagues has been essential for our physical and mental health, as well as our professional well-being.

It’s one of the reasons starting the Broker Bulletin six months ago was so important. It enabled us to be a resource for you, so that you could support your clients’ needs. I hope you have been finding this bulletin beneficial. In fact, we’d very much like to know what you think of it so far and ask that you please take this brief survey.

Last month, I mentioned that 2022 promises to be an exciting year for Fallon Health. And to kick it off, I am pleased to share with you that brokers will soon be able to refer clients to our Program of All-Inclusive Care for the Elderly (PACE), Summit ElderCare®. The largest program of its kind in New England, Summit ElderCare pursues excellence in every aspect of providing health care services to older adults in our service area. We look forward to providing you with more details in the coming months.


Deb Daviau

VP of Medicare and Executive Director of NaviCare

OptumRx Home Delivery program

If your clients have prescription drug benefits through Fallon Health, they don’t need to leave the house to get their medications—those can be delivered right to their door, and the shipping is free anywhere in the U.S.

Fallon members who have been taking maintenance medications—the same medications for a few months or longer, with no plans to change—can use the OptumRx Home Delivery program. Signing up is easy. They can:

  • Enroll in home delivery at optumrx.com (members must have prescription information on hand)
  • Ask their doctor to fax or electronically send a new prescription to OptumRx Home Delivery (providers contracted with the plan will have the information they need to do this)
  • Call OptumRx at 1-844-657-0494 (TRS 711), 24 hours a day, seven days a week (members should have their medication information and prescriber information on hand, as OptumRx will contact the prescriber on their behalf)

For more information:

Tips for using the Benefit Bank card

Our Benefit Bank program gives members the flexibility to spend their Benefit Bank dollars as they choose: on everything from dental care and eyewear to hearing aids, fitness memberships and online WW® memberships. See our Benefit Bank webpage for complete details. Here are some handy tips for using the card:

  • Before using the card, members must make sure it has been activated by calling 1-833-647-9633 (TRS 711). Activation instructions can be found on the Benefit Bank page of our website.
  • Members should check their balance before making any purchases (they can check any time online at https://members.fallonhealth.org/member-portal/login). The card can only be processed for the available amount or lower, which means members are responsible for any costs that exceed the available balance.
  • Lost card? Members can call Fallon Health Customer Service at 1-800-325-5669 (TRS 711), 8 a.m.–8 p.m., Monday–Friday (Oct. 1–March 31, seven days a week) to request a replacement card. 

Care Connect helps Fallon members get the care they need

Sometimes, you can’t reach your own doctor and you need immediate care for a non-urgent issue. For Fallon Health members, there is another option.

With Care Connect, Fallon Medicare PlusTM (FMP) members have 24/7 phone access to registered nurses who will recommend where members should receive care or will connect members with their doctor. FMP members should call 1-800-609-6175 (TDD/TTY 1-800-848-0160).

NaviCare® members can call 1-877-700-6996 (TRS 711), 8 a.m.–8 p.m., Monday–Friday (Oct. 1–March 31, seven days a week) to speak with our Enrollee Services team who can help them get to the right person. Any calls after hours will be transferred to Care Connect.

These phone numbers are also located on the back of Fallon Health member ID cards.

NaviCare enrollment dates

Our NaviCare plan provides members with benefits, items and services that are covered by Medicare and MassHealth Standard—plus more. Members of Fallon Health's NaviCare® SCO and NaviCare® HMO SNP receive all the care and services they need at no cost to them. There may be certain times of the year that you can enroll your clients in NaviCare, depending on the plan:

NaviCare SCO – Your eligible clients can enroll at any time. Coverage will begin the first day of the following month.

NaviCare HMO SNP – Your eligible clients can enroll once per calendar quarter during the first three quarters of the year (January­­–March, April–June or July–September); coverage begins the first day of the following month. They can also enroll during Medicare’s Annual Enrollment Period, October 15–December 7; coverage begins on January 1.

OEP at the halfway mark

As you know, OEP is the time of year when Medicare Advantage enrollees who aren’t happy with their current plan have an opportunity to change their coverage and/or switch plans. Should any of your clients tell you they’re reconsidering their Medicare options, we’ll be able to process any new enrollments or plan changes you submit to us by the end of the business day on March 31. Enrollments can be submitted to us online at https://fallon.sunfirematrix.com/app/agent/fchp, emailed to us at MedicareSalesBrokers@fallonhealth.org or faxed to us at 1-508-757-0572.

Join our broker team

If you haven’t already, please check out the broker pages on our website. You can find information there about becoming a broker with Fallon and tools you can use if you are already a broker with us. 

If you aren’t ready to become a Medicare broker with us, we also have a broker referral program that you can take advantage of. Fallon offers competitive compensation to agents and brokers who provide us with member referrals for several of our plans within our government programs products portfolio. For more information, please call our Medicare support team Monday–Friday, 8:30 a.m.–5 p.m., at 1-844-848-4931 (TRS 711), or email us at MedicareSalesBrokers@fallonhealth.org.

Contact us

Our easy-to-reach Broker Relations team is available to you at every stage of the sales process. We provide you with personalized support over the phone.

Call us today:


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