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Choice Copay Plan Overview

Our HMO Choice Copay plan is a high-quality managed care plan that is simple to administer. There are no claim forms to fill out—most services are covered with just a copayment. Choice Copay works like a traditional HMO plan, but members pay different copayments for services depending on where they receive care.

The HMO Choice Copay plan features:

  • Emergency and urgent care coverage anywhere in the world, 24 hours a day, seven days a week.
  • Comprehensive disease management and wellness programs at no extra charge.
  • Discounts on fitness club memberships, acupuncture, massage, and more.

How the Plan Works

HMO Choice Copay members must choose a primary care provider (PCP), who must provide or authorize all care. A member simply presents his or her ID card and pays a copayment when he or she visits the PCP. When a member needs specialty care, the PCP will refer him or her to a specialist within our network. A member is required to obtain a referral in order to receive coverage for the specialist’s services.

Members pay a lower copayment for PCP office visits and a higher copayment for specialist office visits.

For inpatient hospital care, HMO Choice Copay members pay a lower copayment when admitted to a community hospital and a higher copayment when admitted to generally more expensive tertiary hospitals.

Pharmacy Coverage

If your plan includes the optional pharmacy benefit, members will pay a copayment for each prescription, according to our three-tier pharmacy copayment program:
  • Tier 1: Lowest copayment; includes most generic drugs
  • Tier 2: Middle copayment; includes many brand-name drugs
  • Tier 3: Highest copayment; includes the most costly covered brand-name drugs not included in other tiers.

Superior Customer Service

Our Member Services department offers your employees a staff of highly trained professionals. One phone call is all it takes to reach our Member Specialists. They are available to answer members’ questions about the plan and their benefits. We also offer language-translation services and TTY capabilities as needed.

Note: This a summary of the plan features. Please refer to the benefit document for a detailed explanation of coverage. If there is a difference between the information in this document and the benefit document, the terms of the benefit document will govern.

For more information, contact your sales office:
Watertown 800-208-8013 | Worcester 800-208-9545 | Providence 800-455-2012
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