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The Advantage: Frequently asked questions

• Overview

• Doctors and hospitals FAQ

• Benefits, copayments, deductibles and cost savings FAQ

• Value-added extra benefits FAQ

• Care Management/Transition of Care FAQ

Overview

Q. What is the City of Worcester Advantage?

A. The City of Worcester Advantage is a health plan, built exclusively for City of Worcester employees, in partnership with local providers—UMass Memorial Health Care, Saint Vincent Hospital and Fallon Clinic—and Fallon Community Health Plan, one of the top ten health plans in the country. This health plan offers two options: the Advantage plan and the Direct plan. The Advantage plan has a large group of 24,000 doctors and hospitals throughout Massachusetts and southern New Hampshire—and if you get health care from local doctors and hospitals, you’ll pay less. The Direct plan has a smaller group of doctors and hospitals to choose from, and you’ll pay the same low copayments no matter where you go. Both options have low premiums, and lots of extra benefits.

Q. Can you explain a little more about the Advantage plan and how it works?

A. The Advantage plan gives you the power to choose what you pay out of your own pocket, based on where you get your care. The Advantage plan is built around Worcester’s finest providers, including UMass Memorial Health Care, Saint Vincent Hospital and Fallon Clinic, all of which are in the lower cost Tier 1 of the Advantage plan. That means you will pay lower copayments when you get your health care locally. In addition to these local providers, you also have access to a larger group of providers—over 24,000 throughout Massachusetts and southern New Hampshire—in Tier 2. And, when you choose the Advantage plan, you will get one month premium free!

Q. Can you explain a little more about the Direct plan and how it works?

A. The Direct plan has a smaller group of local doctors and hospitals to choose from, and with this plan, you pay the same low copayments no matter where you get your care. The more than 14,000 providers in the Direct plan were carefully chosen for their medical excellence, and their ability to work closely with their patients to provide the best care possible while keeping health care costs down. And, when you choose the Direct plan, you will get two months premium free!

Q. What is different from my current FCHP Direct plan to the Direct plan?

A. With the Direct plan, you’ll have:

• No premium contribution taken out of your paycheck for two months; and if you’re on a settled plan, you’ll have lower weekly premiums. If you’re on a non-settled plan, your weekly premiums will be slightly higher.

• An increased fitness reimbursement benefit to $400 family/$200 individual.

• The same network of over 14,000 providers.

• Access to Boston hospitals through the Peace of Mind benefit.

• A $200 individual/$600 family deductible.

Q. What is different from my current FCHP Direct plan to the Advantage plan?

A. With the Advantage plan, you’ll have:

• Slightly higher weekly premiums – plus you’ll have no premium contribution taken out your paycheck for one month.

• An increased fitness reimbursement benefit to $400 family/$200 individual.

• A larger tiered network with over 24,000 providers throughout Massachusetts and southern New Hampshire. Tier 1 includes UMass Memorial Health Care, Saint Vincent Hospital, Fallon Clinic and other local providers. Tier 2 includes all other network providers.

• You will pay a lower copayment for inpatient stays, same-day surgery and office visits when you see Tier 1 providers.

• Access to Boston hospitals through the Peace of Mind benefit.

• A $250 individual/$750 family deductible.

Q. What is different from my current FCHP Select plan to the Direct plan?

A. With the Direct plan, you’ll have:

• No premium contribution taken out of your paycheck for two months; and if you’re on a settled plan, you’ll have lower weekly premiums. If you’re on a non-settled plan, your weekly premiums will be slightly higher.

• An increased fitness reimbursement benefit to $400 family/$200 individual.

• A smaller network with over 14,000 providers.

• You’ll still have access to Boston hospitals through the Peace of Mind benefit

• A $200 individual/$600 family deductible.

Q. What is different from my current FCHP Select plan to the Advantage plan?

A. With the Advantage plan, you’ll have:

• No premium contribution taken out of your paycheck for one month; and if you’re on a settled plan, you’ll have lower weekly premiums.

• An increased fitness reimbursement benefit to $400 family/$200 individual.

• The same network of over 24,000 providers throughout Massachusetts and southern New Hampshire. Providers are tiered into two categories. Tier 1 includes local providers like UMass Memorial Health Care, Saint Vincent Hospital, Fallon Clinic and other providers. Tier 2 includes all other network providers.

• You will pay a lower copayment for inpatient stays, same-day surgery and office visits when you see Tier 1 providers.

• Access to Boston hospitals through the Peace of Mind benefit

• A $250 individual/$750 family deductible.

Q. What is different from my current Blue Cross Blue Shield plan to the Direct plan?

A. With the Direct plan, you’ll have:

• Lower weekly premiums – plus you’ll have no premium contribution taken out your paycheck for two months.

• An increased fitness reimbursement to $400 family/$200 individual.

• A smaller network of doctors with over 14,000 providers throughout central and eastern Massachusetts.

• Access to Boston hospitals through the Peace of Mind benefit

• A $200 individual/$600 family deductible.

Q. What is different from my current Blue Cross Blue Shield plan to the Advantage plan?

A. With the Advantage plan, you’ll have:

• Lower weekly premiums – plus you’ll have no premium contribution taken out your paycheck for one month.

• An increased fitness reimbursement to $400 family/$200 individual.

• A smaller network of over 24,000 providers throughout Massachusetts and southern New Hampshire. Providers are tiered into two categories. Tier 1 includes local providers like UMass Memorial Health Care, Saint Vincent Hospital, Fallon Clinic and other providers. Tier 2 includes all other network providers.

• You will pay a lower copayment for inpatient stays, same-day surgery and office visits when you see Tier 1 providers.

• Access to Boston teaching through the Peace of Mind benefit

• A $250 individual/$750 family deductible

Q. I am a non-represented (non-union) employee. Do I have to switch plans?

A. Yes. Your current plans with both Fallon Community Health Plan and Blue Cross Blue Shield will no longer be available. The great news is that you have a new plan available to you, built exclusively for City of Worcester employees, in partnership with local providers—UMass Memorial Health Care, Saint Vincent Hospital and Fallon Clinic—and Fallon Community Health Plan, one of the top ten health plans in the country. This health plan offers two options: the Advantage plan and the Direct plan. The Advantage plan has a large group of 24,000 doctors and hospitals throughout Massachusetts and southern New Hampshire—and if you get health care from local doctors and hospitals, you’ll pay less. The Direct plan has a smaller group of doctors and hospitals to choose from, and you’ll pay the same low copayments no matter where you go. Both options have low premiums, and lots of extra benefits. And, if you join the Direct plan during this open enrollment period, you will get two months premium-free; if you join the Advantage plan during this open enrollment period, you will get one month premium-free!

Q. I am a represented (union) employee. Do I have to switch plans?

A. At this point in time, you do not have to switch plans. You can decide to stay with the plan that you have today. However, you might want to take a look at The City of Worcester Advantage and all it has to offer. The City of Worcester Advantage was built exclusively for City of Worcester employees, in partnership with local providers—UMass Memorial Health Care, Saint Vincent Hospital and Fallon Clinic—and Fallon Community Health Plan, one of the top ten health plans in the country. This health plan offers two options: the Advantage plan and the Direct plan. The Advantage plan has a large group of 24,000 doctors and hospitals throughout Massachusetts and southern New Hampshire—and if you get health care from local doctors and hospitals, you’ll pay less. The Direct plan has a smaller group of doctors and hospitals to choose from, and you’ll pay the same low copayments no matter where you go. Both options have low premiums, and lots of extra benefits. And, if you join the Direct plan during this open enrollment period, you will get two months premium-free; if you join the Advantage plan during this open enrollment period, you will get one month premium-free!

Q. I am an early retiree. Do I have to switch plans?

A. No. At this time, you can remain on your current health plan if you choose. However, your current health plan will be phased out some time this year, and at that point, you will have to switch to a new plan. You might want to look at The City of Worcester Advantage now. If you switch during this open enrollment period, you will get either one or two months premium free!

The City of Worcester Advantage was built exclusively for City of Worcester employees, in partnership with local providers—UMass Memorial Health Care, Saint Vincent Hospital and Fallon Clinic—and Fallon Community Health Plan, one of the top ten health plans in the country. This health plan offers two options: the Advantage plan and the Direct plan. The Advantage plan has a large group of 24,000 doctors and hospitals throughout Massachusetts and southern New Hampshire—and if you get health care from local doctors and hospitals, you’ll pay less. The Direct plan has a smaller group of doctors and hospitals to choose from, and you’ll pay the same low copayments no matter where you go. Both options have low premiums, and lots of extra benefits. And, if you join the Direct plan during this open enrollment period, you will get two months premium-free; if you join the Advantage plan during this open enrollment period, you will get one month premium-free!

Doctors and hospitals

Q. How do I know if my doctor is in the Direct plan?

A. The City of Worcester Advantage Direct plan network is powered by the Fallon Community Health Plan Direct Care network.

These are the provider groups that are currently included in the Direct plan

• Acton Medical Associates

• Cape Ann Medical Center

• Cape Ann Pediatrics

• Charles River Medical Associates

• Fallon Clinic

• Greater Lawrence Family Health Center

• Highland Healthcare Associates IPA

• Lahey Clinic

• Lawrence General IPA

• Lowell General PHO

• Mount Auburn Cambridge Independent Practice Association

• Northeast PHO

• Signature Healthcare Bridgewater Goddard Park Medical Associates and affiliated providers

• Signature Healthcare Brockton Hospital and affiliated providers

• Southboro Medical Group

• South Shore PHO

• Woburn Pediatric Associates

If you’re not sure if you doctor belongs to one of the medical groups listed above, there are a few ways to find out if he/she is in the Direct plan.

• Download the provider list using the links in the "Important Information" bar to the right

• You can call our dedicated sales team at 1-866-674-6112 and a representative an look up your doctor for you

• Visit an information session to speak to a representative

You can also call your doctor directly to find out if he/she is in the Direct plan. If your doctor is unfamiliar with the Direct plan, ask if they accept Fallon Community Health Plan Direct Care. If the answer is yes, then they also accept The City of Worcester Advantage Direct plan.

Q. How do I know if my doctor is in the Advantage plan? How will I know what tier he/she is on?

A. The Advantage plan network was built around local providers, including UMass Memorial Health Care, Saint Vincent Hospital and Fallon Clinic, which are all in tier 1. The network, which is powered by Fallon Community Health Plan, also includes a total of 24,000 doctors and hospitals throughout Massachusetts and southern New Hampshire.

To find out what doctors are included in Advantage, you can:

• Download the provider list using the links in the "Important Information" bar to the right

• Call our dedicated sales team at 1-866-674-6112 and a representative an look up your doctor for you

• Visit an information session to speak to a representative

You can also call your doctor directly to find out if he/she is in the Advantage plan. If your doctor is unfamiliar with the Advantage plan, ask if they accept Fallon Community Health Plan Select Care. If the answer is yes, then they also accept the Advantage plan.

If your doctor belongs to UMass Memorial Health Care, Fallon Clinic or Saint Vincent Physician Services, great news—they are included in tier 1! If you aren’t sure if your doctor belongs to one of those groups, you can look at the Advantage plan provider list on our Web site. Alongside the provider name, specialty and location, there is a note to show what tier each doctor is in—tier 1 or tier 2. You can also call us at 1-866-674-6112, and we can help you determine what tier your doctor is in.

Q. How did you decide what doctors and hospitals are on what tiers?

A. We believe that local care is the best care—we have world-renowned hospitals and doctors right here in Worcester. That’s why the City of Worcester is partnering with UMass Memorial Health Care, Saint Vincent hospital, Fallon Clinic, and other local doctors and hospitals to create the Advantage plan. All of these local provider partners are included on tier 1. The rest of the Advantage plan doctors and hospitals are on tier 2.

Q. What if I want to go to a Boston hospital?

A. The City of Worcester Advantage provides guaranteed access to Boston through the Peace of Mind Program. You can receive a second opinion, and treatment for specialty services, at one of five of Boston’s best hospitals: Brigham and Women’s hospital, Children’s Hospital, Dana-Farber Cancer Institute, Massachusetts General Hospital and Tufts Medical Center.

Q. How does the Peace of Mind Program benefit work?

A. The Peace of Mind Program is a benefit available to members of The City of Worcester Advantage. It provides you with access to receive a second opinion and treatment for specialty services at one of five Boston hospitals. There are some eligibility requirements for the Peace of Mind program:

• You must have seen a specialist, in your network, for the same condition within the past three months. For example, if you have seen an in-network Orthopedic Surgeonwithin the past three months, you can see an Orthopedic Surgeonat a Peace of Mind Program facility. However, if you have seen an in-network Orthopedic Specialistwithin the past three months, you can see an Orthopedic Specialist at a Peace of Mind Program facility, but not an Orthopedic Surgeon.

• The specialty services you are seeking must be covered services (see your Member Handbook/Evidence of Coveragefor a listing of services covered with your plan). Services that are not available through the Peace of Mind Program include primary care services, mental health, substance abuse, dental care, chiropractic services, obstetrics, speech therapy and infertility services.

• Your PCP must request a prior authorization from The City of Worcester Advantage for you to see a Peace of Mind Program specialist. Your PCP cannot deny you the right to request access to your Peace of Mind Program benefit.

As long as you have met the eligibility requirements, you have the right to access your Peace of Mind Program benefit. Your PCP cannot deny you that right. If you have difficulty receiving a referral from your PCP, call The City of Worcester Advantage customer service team.

Q. Children’s Hospital and Tufts Medical Center are listed as tier 2 of the Advantage plan. If I join the Advantage plan, do I have to use the Peace of Mind Program to access these hospitals?

A. No. Members of the Advantage plan have access to both Children’s Hospital and Tufts Medical Center, if they receive a referral from their PCP. However, if they do not get a referral from their PCP, they can use their Peace of Mind Program benefit to access a second opinion and specialty care at Children’s Hospital or Tufts Medical Center, as well any of the other three facilities.

Q. If I go to a Peace of Mind hospital, would I pay the tier 1 copay or the tier 2 copay?

A. If you are on the Advantage plan, and you use our Peace of Mind program benefit, you would pay the tier 2 copay to go to one of the five Boston hospitals included in the program: Brigham and Women’s hospital, Children’s Hospital, Dana-Farber Cancer Institute, Massachusetts General Hospital and Tufts Medical Center. If you are on the Direct plan, there is just one copay no matter where you go.

Q. If I choose the Advantage plan, can I only see tier 1 doctors?

A. No. You can see any doctor, or visit any hospital, included in the Advantage plan network, which is the group of doctors and hospitals included in the plan. But some doctors and hospitals, including UMass Memorial Health Care, Saint Vincent Hospital and Fallon Clinic are all in Tier 1. If you receive care from these doctors and hospitals, you will pay less than if you receive care from a doctor or hospital in Tier 2.

Q. If I see a specialist now that is not in the network, will I be able to continue to see that specialist and have it covered?

A. Both the Direct plan and the Advantage plan of The City of Worcester Advantage are HMO plans; which means that in order for you to receive coverage for services you need to see in-network providers. If you choose to see a provider who is not in the network, services will not be covered. The only exception is emergency care—with The City of Worcester Advantage, you are covered for worldwide emergency care, no matter where you receive it.

However, if you are currently in medical treatment with a provider who is not in the network, you can work with our care coordination team who can help to try to prevent any interruptions in care by finding a participating provider for your needs. If you’d like to speak with someone about how your care would be transitioned with The City of Worcester Advantage, please call our dedicated team at: 1-866-674-6112.

Benefits, copayments, deductibles and cost savings

Q. What is a premium incentive?

A. Having a premium incentive means that you will pay no contribution towards your health insurance premium for a certain period of time. If you join the Direct plan, you will pay no premium for two months! And if you join the Advantage plan, you pay no premium for one month.

Q. What happens if I have an emergency and I am travelling?

A. With The City of Worcester Advantage, you have worldwide emergency coverage. That means that if you, or a dependent, experience a medical emergency while away from home, you can go to any emergency room and be covered. You would then need to notify The City of Worcester Advantage of any emergency services received, and we recommend that you also contact your PCP to coordinate any follow-up care.

Q. If I go to the hospital, would I have to pay the deductible as well as a copay?

A. You would likely pay both the deductible and the copay, until you have fulfilled your deductible. Here is an example:

Joe has the Advantage plan, and a $250 individual deductible. He needs to have his hip replaced and he decides to go to a tier 1 hospital, which has a $250 copayment. If the total hospital cost is $2,750, he would pay his $250 deductible, then his $250 copayment. The Advantage plan would pay the remaining $2,200 of the bill. Joe has now fulfilled his deductible for the year. If he has to go into the hospital later in the year, he would pay his $250 copayment, and nothing else.

Q. For services that say “copayment after deductible”, would I have to pay the deductible as well as a copay until I’ve paid my whole deductible?

A. There are some benefits with The City of Worcester Advantage, which have a copayment after the deductible. But in most cases, you would not pay both the copay and the deductible. Here are some examples:

• Steve is on the Direct plan, which has a $200 individual deductible. He hurt his back, and goes to see a physical therapist. The total cost of his visit is $75. Because physical therapy visits go toward the deductible, and Steve hasn’t paid his $200 deductible yet, he would pay the full $75. But he would not have to pay the $15 copayment.

• Beth is on the Advantage plan, which has a $250 individual deductible. She also has a visit with the physical therapist. But because she has already paid her entire deductible, she will pay the $20 copayment for her visit.

Q. What is tiering?

A. Tiering is simply a fancy way of showing where you can get your health care for less, and where you will pay more. With the Advantage plan, you pay a lower copayment for tier 1 doctors and hospitals than for tier 2 doctors and hospitals.

Q. How does a deductible work?

A. You are probably already familiar with the idea of a deductible, since most likely you have a deductible on your car insurance policy—it’s that first $500 or $1,000 you have to pay before your insurance covers repair costs. Much the same way, your health insurance deductible is a set dollar amount that you must pay out of your pocket before the City of Worcester Advantage will pay for services.

Preventive services are not subject to the deductible. For these types of services, you may have to pay a copayment (where you pay a set amount for services). What is considered “preventive?”Something you have done routinely or regularly to prevent illness, such as getting a flu shot.

But if you go to the doctor every few months to monitor an existing illness to prevent it from getting worse, that’s considered treatment. If you have diabetes and go in for a quarterly checkup for bloodwork, etc., that’s a diagnostic service. Treatment and diagnostic services are usually subject to a deductible.

Q. What is the definition of preventive care?

A. Preventive Care includes services received at your routine annual visit with your primary care provider and can also include tests, immunizations, and services geared to help screen for diseases and improve early detection.

Q. What is considered a “preventive” service versus a “diagnostic” service?

A. A “preventive” service is something you have done routinely or regularly to prevent illness, such as getting a flu shot. A diagnostic service would be considered treatment, like if you go to the doctor every few months to monitor an existing illness to prevent it from getting worse.

Q. What happens if I get billed for something that should have been part of my $0 wellness visit?

A. In most cases, services you would receive as part of your $0 wellness visit would be considered ‘preventive’ and would be no charge to you. However, if you have an ongoing existing illness that is monitored by bloodwork at your annual wellness visit, that could be billed by your doctor as being diagnostic. Rule of thumb: If your doctor bills a service as being “diagnostic,” instead of “preventive,” you may have to pay out-of-pocket costs. If you come across an issue like this, you should call the City of Worcester Advantage dedicated customer service team, and they can help you.

Q. What does it mean when you say: The most any one person will pay towards the deductible?

A. That refers to the maximum amount that any one family member will pay before their portion of the deductible is fulfilled. So, if a family is on the Advantage plan, which has a $750 family deductible, no one member of that family will have to pay more than $250 towards that deductible. And if another family is on the Direct plan, which has a $600 family deductible, no one member of that family will have to pay more than $200 towards that deductible.

Q. What is a “hospital setting” versus a “non-hospital setting?”

A. A hospital setting is just that—a medical center that provides inpatient stays and emergency care plus other types of services. A non-hospital setting would be a facility that only provides imaging services—a place where you would have an MRI or a CT scan, but you would not stay overnight or go for emergency care. With The City of Worcester Advantage, when you have imaging (MRI’s, CT scans, etc) done in a non-hospital setting, you will pay less than if you have those kinds of tests done in a hospital setting.

Q. What is an out-of-pocket Maximum?

A. The out of pocket maximum is most that you will pay out of your own pocket annually in deductibles and copayments. The out-of-pocket maximum protects you by capping the amount that you will have to pay for your health care in any given year. For example, if you and your family choose the Direct plan, the most that you would have to pay out of your own pocket for the coming year is $3,000 (for an individual, the most you would have to pay is $1,500). With the Advantage plan, the most that a family would have to pay out-of-pocket for the coming year would be $4,000 (for an individual, the most you would have to pay is $2,000).

Q. How much money is the city saving by offering these plans?

A. According to City Manager Michael V. O’Brien, the City could reduce the city’s fiscal 2012 deficit by $5 million, while saving valuable City jobs, if all city-side employees agreed to move to an option in The City of Worcester Advantage.

Q. How much can I save if I join one of these plans?

A. It really depends on your situation. We highly recommend that you take a look at our Comparison Guide tool. It shows you the costs of The City of Worcester Advantage options compared with other options available to you. How much you save will depend on things like, will you have a hospital stay, how many times will you go to the doctor, do you have any same-day surgeries coming up, will you use your $400 family/$200 individual fitness benefit, etc. We know that everyone is different, so it wouldn’t be fair to say that everyone will save a certain amount of money. We believe that some will save thousands, some will save hundreds, but everyone can save money with the City of Worcester Advantage. You are guaranteed a premium incentive, no matter which plan you choose. With the Direct plan, you will get two months premium free, and with the Advantage plan, you will get one month premium free.

Q. I have a dependent child who is a student out-of-state. Is that child covered on the City of Worcester Advantage?

A. Yes, but the services they can access while at school are limited. Students attending school outside the City of Worcester Advantage service area may not have easy access to the plan provider network. They would be covered for a limited number of services while out-of-area, if those services are authorized in advance by The City of Worcester Advantage. You must work with your PCP to get plan authorization. These services include:

• Non-routine medical office visits

• Diagnostic lab and X-ray connected with a non-routine office visits

• Non-elective inpatient services

• Outpatient services to treat the abuse of or addiction to alcohol or drugs, up to 20 office visits in each calendar year while out of the City of Worcester Advantage service area

• Outpatient services to diagnose and/or treat mental conditions

• Short-term rehabilitation services, including physical, respiratory, speech and occupational therapy. Coverage is provided for up to 20 office visits per discipline in each calendar year per illness or injury (combined with any in-area visits).

Aside from emergency care, the services listed above are the only services that are covered for students on an out-of-network basis. To be covered, all other services must be obtained when the student returns to the City of Worcester Advantage service area.

Value-added extra benefits

Q. What is the It Fits! benefit?

A. It Fits! is the richest fitness benefit available in Massachusetts. As a member of The City of Worcester Advantage, you can use your It Fits! annual reimbursement of $400 for families/$200 for individuals to pay for all kinds of healthy activities, including school and town sports, ski lift tickets, exercise classes, dance lessons, a gym membership at any gym, and much more. Most fitness benefits offer “discounts,” or reimbursements at a limited list of gyms. With It Fits!, you go where you want to go, and you get paid back.

Q. How do I get the $400/$200 fitness money?

A. Once you have a receipt for a healthy, reimbursable activity, like school and town sports fees, or a gym membership at the gym of your choice, or even ski lift tickets, you can send those receipts in with an It Fits form. You can decide to send all of your receipts for the year in at once to make things easier for you. Once we receive the form, we ask that you allow 2-4 weeks to get your check in the mail. It’s that easy!

Q. What is covered through Naturally Well?

A. Naturally Well gives you discounts on acupuncture, chiropractic care (in addition to your chiropractic benefit) and massage therapy from the American Specialty Health Networks, Inc. (ASHN) network of qualified providers. Health and wellness products also are available at a reduced rate through ChooseHealthyTM, an affiliate of ASHN. The services and products are not covered benefits under your health plan coverage, but are an extra value if you wish to use them.

Q. What is the Oh Baby! program all about?

A. As a member of The City of Worcester Advantage, and as a new parent-to-be, the Oh Baby! program provides you with free prenatal vitamins, a car seat or breast pump, a home safety kit and more—plus reimbursements on childbirth or sibling classes, discounts on birth announcements, and even a chance to win an American Express® Gift Cheque.

Q. What other extras does The City of Worcester Advantage include?

A. The City of Worcester Advantage provides its members with lots of extras to keep you, and your wallet, healthy, including:

• $0 wellness benefit! Copayments are $0 for routine physicals, gynecological exams, well-child care visits and annual vision exams.

• 20% discount at CVS/pharmacy—You get a 20% discount on more than 1,500 CVS/pharmacy-brand, health-related products, good at any CVS/pharmacy store or online at .

• Fitness center discounts—In addition to the It Fits! Reimbursement, members receive reduced rates on memberships to more than 70 health club facilities in Massachusetts.

• Eyewear discounts—Members save up to 35% at contracted vendors, including frames, prescription lenses and nonprescription sunglasses.

• Nurse Connect—For those times when you’re not feeling well, but don’t think it’s an emergency, call the registered nurses at Nurse Connect. The City of Worcester Advantage members get free access—by phone and online—24 hours a day, seven days a week, 365 days a year.

• FCHP Family Fun—You’ll get discounted admissions and other savings at area attractions and activities, including indoor mountain climbing, museums, sports facilities and zoos.

• Quit to Win—Smokers get access to this free counseling program with tobacco cessation experts in a group setting, or by telephone.

• Healthwise Knowledgebase—This free online encyclopedia features information on diseases, treatment, medications and other important health topics.

Care Management/Transition of Care

Q. I have diabetes. How will my care be managed with this plan?

A. The City of Worcester Advantage has care management programs for every level of risk for diabetes and other chronic conditions. From providing educational tools and screening reminders, to developing a care plan built specifically for you and coordinating services, The City of Worcester Advantage provides all of our members with chronic conditions care management appropriate to their needs.

If you’d like to speak with someone about how your care would be transitioned with The City of Worcester Advantage, please call our dedicated team at 1-866-674-6112.

Q. I’m pregnant. What happens if I switch to your plan during my pregnancy?

A. Congratulations! The City of Worcester Advantage has a comprehensive “transition of care” process to be sure that you can continue to get the care you need with providers you trust. If you’d like to speak with someone about how your care would be transitioned with The City of Worcester Advantage, please call our dedicated team at 1-866-674-6112.

And, you will want to be sure to sign up for the Oh Baby! program. As a member of The City of Worcester Advantage, and as a new parent-to-be, you can get free prenatal vitamins, a car seat or breast pump, a home safety kit and more—plus reimbursements on childbirth or sibling classes, discounts on birth announcements, and even a chance to win an American Express® Gift Cheque.

Important information

Find a doctor

Advantage plan

• Primary care providers and specialists (Excel, 5 MB - Download Excel Viewer)

• Hospitals (pdf, 245 KB)

Direct plan

• Primary care providers and specialists (Excel, 8 MB - Download Excel Viewer)

• Hospitals (pdf, 117 KB)

Other important information

• Frequently asked questions

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