Benefit summaries and Summaries of Benefits and Coverage (SBC) for our health insurance plans

A variety of low cost plan designs with flexible benefit options and a choice of networks.

To download a benefit summary or SBC for your current plan year, click the "See more" link that corresponds to your plan's effective date. Please note: These documents do not include customizations. These are the standard plan designs. If you need documents for a plan with an earlier effective date, please contact Jen Lavigne at jennifer.lavigne@fchp.org.

2013

April 1, 2013

Tiered Choice

Options within a tiered provider network
$0 Deductible $1000 Deductible $0/$2000 Deductible

HMO and PPO plans

Premium Saver: affordable options that include inpatient copayments at premium savings
FCHP Steward Community Care network Direct Care network Select Care network Preferred Care network
Premium Saver I Premium Saver I Premium Saver I Premium Saver I
Premium Saver II Premium Saver II Premium Saver II Premium Saver II
Premium Saver Value I Premium Saver Value I Premium Saver Value I Premium Saver Value I
Premium Saver Basic I Premium Saver Basic I Premium Saver Basic I Premium Saver Basic I
Premium Saver Basic II Premium Saver Basic II Premium Saver Basic II Premium Saver Basic II
Premium Saver 65/35 Premium Saver 65/35 Premium Saver 65/35

Deductible options: plan designs that provide even greater premium savings by offering deductibles for inpatient services and diagnostic testing
FCHP Steward Community Care network Direct Care network Select Care network Preferred Care network
Premium Saver 500 Premium Saver 500 Premium Saver 500 Premium Saver 500
Premium Saver 1000 Premium Saver 1000 Premium Saver 1000 Premium Saver 1000
Premium Saver 1000 Classic Premium Saver 1000 Classic Premium Saver 1000 Classic Premium Saver 1000 Classic
Premium Saver 1000 Classic West
Premium Saver 1500 Premium Saver 1500 Premium Saver 1500 Premium Saver 1500
Premium Saver 1500 Classic Premium Saver 1500 Classic Premium Saver 1500 Classic Premium Saver 1500 Classic
Premium Saver 2000 Classic Premium Saver 2000 Classic Premium Saver 2000 Classic Premium Saver 2000 Classic
Premium Saver 2000 Classic West
Premium Saver 2000/500 I Premium Saver 2000/500 I Premium Saver 2000/500 I Premium Saver 2000/500 I
Premium Saver 2000/500 II Premium Saver 2000/500 II Premium Saver 2000/500 II Premium Saver 2000/500 II
Premium Saver 3000 with Rx Premium Saver 3000 with Rx Premium Saver 3000 with Rx Premium Saver 3000 with Rx

Care Choice: qualified high deductible plans that may be partnered with a Health Savings Account (HSA)
FCHP Steward Community Care network Direct Care network Select Care network Preferred Care network
Care Choice 1250 Care Choice 1250 Care Choice 1250 Care Choice 1250
Care Choice 2000 Care Choice 2000 Care Choice 2000 Care Choice 2000

January 1, 2013

Tiered Choice

Options within a tiered provider network
$0 Deductible $1000 Deductible $0/$2000 Deductible

HMO and PPO plans

Premium Saver: affordable options that include inpatient copayments at premium savings
FCHP Steward Community Care network Direct Care network Select Care network Preferred Care network
Premium Saver I Premium Saver I Premium Saver I Premium Saver I
Premium Saver II Premium Saver II Premium Saver II Premium Saver II
Premium Saver Value I Premium Saver Value I Premium Saver Value I Premium Saver Value I
Premium Saver Basic I Premium Saver Basic I Premium Saver Basic I Premium Saver Basic I
Premium Saver Basic II Premium Saver Basic II Premium Saver Basic II Premium Saver Basic II
Premium Saver 65/35 Premium Saver 65/35 Premium Saver 65/35

Deductible options: plan designs that provide even greater premium savings by offering deductibles for inpatient services and diagnostic testing
FCHP Steward Community Care network Direct Care network Select Care network Preferred Care network
Premium Saver 500 Premium Saver 500 Premium Saver 500 Premium Saver 500
Premium Saver 1000 Premium Saver 1000 Premium Saver 1000 Premium Saver 1000
Premium Saver 1000 Classic Premium Saver 1000 Classic Premium Saver 1000 Classic Premium Saver 1000 Classic
Premium Saver 1500 Premium Saver 1500 Premium Saver 1500 Premium Saver 1500
Premium Saver 1500 Classic Premium Saver 1500 Classic Premium Saver 1500 Classic Premium Saver 1500 Classic
Premium Saver 2000 Classic Premium Saver 2000 Classic Premium Saver 2000 Classic Premium Saver 2000 Classic
Premium Saver 2000/500 I Premium Saver 2000/500 I Premium Saver 2000/500 I Premium Saver 2000/500 I
Premium Saver 2000/500 II Premium Saver 2000/500 II Premium Saver 2000/500 II Premium Saver 2000/500 II
Premium Saver 3000 with Rx Premium Saver 3000 with Rx Premium Saver 3000 with Rx Premium Saver 3000 with Rx

Care Choice: qualified high deductible plans that may be partnered with a Health Savings Account (HSA)
FCHP Steward Community Care network Direct Care network Select Care network Preferred Care network
Care Choice 1250 Care Choice 1250 Care Choice 1250 Care Choice 1250
Care Choice 2000 Care Choice 2000 Care Choice 2000 Care Choice 2000

2012

August 1, 2012 through December 2012

Tiered Choice

Options within a tiered provider network
$0 Deductible $0/$1000 Deductible $1000 Deductible $0/$2000 Deductible

HMO and PPO plans

Premium Saver: affordable options that include inpatient copayments at premium savings
FCHP Steward Community Care network Direct Care network Select Care network Preferred Care network
Premium Saver I Premium Saver I Premium Saver I Premium Saver I
Premium Saver II Premium Saver II Premium Saver II Premium Saver II
Premium Saver Value I Premium Saver Value I Premium Saver Value I Premium Saver Value I
Premium Saver Basic I Premium Saver Basic I Premium Saver Basic I Premium Saver Basic I
Premium Saver Basic II Premium Saver Basic II Premium Saver Basic II Premium Saver Basic II
Premium Saver 65/35 Premium Saver 65/35 Premium Saver 65/35

Deductible options: plan designs that provide even greater premium savings by offering deductibles for inpatient services and diagnostic testing
FCHP Steward Community Care network Direct Care network Select Care network Preferred Care network
Premium Saver 500 Premium Saver 500 Premium Saver 500 Premium Saver 500
Premium Saver 1000 Premium Saver 1000 Premium Saver 1000 Premium Saver 1000
Premium Saver 1000 Classic Premium Saver 1000 Classic Premium Saver 1000 Classic Premium Saver 1000 Classic
Premium Saver 1500 Premium Saver 1500 Premium Saver 1500 Premium Saver 1500
Premium Saver 1500 Classic Premium Saver 1500 Classic Premium Saver 1500 Classic Premium Saver 1500 Classic
Premium Saver 2000 Classic Premium Saver 2000 Classic Premium Saver 2000 Classic Premium Saver 2000 Classic
Premium Saver 2000/500 I Premium Saver 2000/500 I Premium Saver 2000/500 I Premium Saver 2000/500 I
Premium Saver 2000/500 II Premium Saver 2000/500 II Premium Saver 2000/500 II Premium Saver 2000/500 II
Premium Saver 3000 with Rx Premium Saver 3000 with Rx Premium Saver 3000 with Rx Premium Saver 3000 with Rx
The plans below are for October 1, 2012 through December 1, 2012 effective dates
Premium Saver 2000/500 II Premium Saver 2000/500 II Premium Saver 2000/500 II Premium Saver 2000/500 II

Care Choice: qualified high deductible plans that may be partnered with a Health Savings Account (HSA)
FCHP Steward Community Care network Direct Care network Select Care network Preferred Care network
Care Choice 1250 Care Choice 1250 Care Choice 1250 Care Choice 1250
Care Choice 2000 Care Choice 2000 Care Choice 2000 Care Choice 2000

FCHP Direct Care is a plan with a limited provider network. This plan provides access to a network that is smaller than FCHP Select Care. In this plan, members have access to network benefits only from the providers in FCHP Direct Care. Please visit our Find a Doctor tool or consult the FCHP Direct Care provider directory to determine which providers are included in FCHP Direct Care. A paper copy can be requested by calling our Customer Service Department at 1-800-868-5200.

FCHP Steward Community Care provides access to a network that is smaller than FCHP Select Care. In this plan, members have access to network benefits only from the providers in FCHP Steward Community Care. Please visit our Find a Doctor tool or consult the FCHP Steward Community Care provider directory to determine which providers are included in FCHP Steward Community Care. A paper copy can be requested by calling our Customer Service Department at 1-800-868-5200.

FCHP Tiered Choice provides access to a network that is smaller than the FCHP Select Care provider network, and includes the tiered provider network called FCHP Tiered Choice. In this plan, members have access to network benefits only from the providers in FCHP Tiered Choice, and may pay different levels of copayments, coinsurance and/or deductibles depending on the tier of the provider delivering a covered service or supply. This plan may make changes to a provider’s benefit tier annually on January 1. Please visit our Find a Doctor tool or consult the FCHP Tiered Choice provider directory to determine which providers are included in FCHP Tiered Choice. A paper copy can be requested by calling our Customer Service Department at 1-800-868-5200.