Fallon accelerates access to health care services for members affected by coronavirus
As the situation with novel coronavirus (COVID-19) continues to develop, Fallon is working to ensure the safety and well-being of our members and staff, while continuing to serve our clients and business partners. Read on for the latest updates. 

Maintaining business continuity and protecting staff
Based on recommendations from the Centers for Disease Control and Prevention (CDC) and the Massachusetts Department of Health (DPH), the vast majority of Fallon Health’s staff is currently working remotely.

As a state-designated essential business, Fallon Health is operating under our normal business hours. We are here to answer your questions and assist you in every way we can, especially during this critical time. While you may experience some slight delays in response time, we are committed to continuing to provide you with the highest level of service.

Policy changes for members’ safety and well-being
Fallon Health has made it easier for members to be tested for—and receive care related to—COVID-19.

Effective immediately, Fallon is doing the following:

Making it easier to get necessary care

  • Removing certain administrative procedures, such as prior authorization for telehealth delivered by in-network providers for COVID-19, as outlined by the Massachusetts Division of Insurance.

  • Waiving early refill limits on drug prescriptions for all Fallon members who fill their maintenance medications at any in-network pharmacy.

  • Members can now receive early refills for certain medications up to a 90-day supply of maintenance medication prescriptions ahead of schedule.

  • Certain pharmacies may offer free home delivery of medications. Members should speak to their pharmacy if they need additional supplies or home delivery services.

  • Offering members access to telehealth services from all network providers that are making them available. Fallon members who have the Teladoc benefit can also use that service.

  • Fallon will waive all member cost-sharing for COVID-19 related medically necessary telehealth services for the duration of Governor Baker’s Emergency Order.

  • Fallon will waive cost-sharing for all non-COVID-19 related medically necessary telehealth services for all members. The one exception is members in HSA-qualified High Deductible Health Plans. Fallon will waive member cost-sharing for these members after the applicable deductible is met. This will also be in effect for the duration of Governor Baker’s Emergency Order.

  • Members who have the NurseConnect benefit can use it to receive medical advice at no cost to the member.

Helping members affected by COVID-19

  • Waiving member cost-sharing (i.e., deductibles, copayments and coinsurance) for medically necessary COVID-19 testing, counseling and vaccinations at in-network doctors’ offices, urgent care centers and emergency rooms for all plan members.

  • Waiving member copayments for medically necessary COVID-19 treatment at in-network doctors’ offices, urgent care centers and emergency rooms for all plan members.

  • Deductibles and co-insurance are not waived for COVID-19-related treatment.

  • Inpatient cost-sharing for COVID-19-related treatment will not be waived.

  • Extending these member cost-sharing policies for COVID-19-related testing and treatment to out-of-network providers, if in-network providers are unavailable.

Improving access to information

  • Our dedicated hotline—1-877-835-8440 (TRS 711)—is staffed with representatives who can address questions about COVID-19, discuss available benefits and provide phone numbers for additional help.

Ongoing monitoring

Fallon continues to monitor the evolving situation. We are reviewing our policies as appropriate while always keeping members’ safety and well-being at the forefront of our decisions.

For the latest information and resources, please visit: fallonhealth.org .