UPDATES FROM FALLON HEALTH - September 2022

There are just about three weeks to go, and final preparations are underway for the start of AEP. It's an important and exciting time of year!

While there is much to do, our priority at Fallon—always—is to make sure our members get the care they need and deserve. As both an insurer and provider of care, we design and deliver services that meet the unique and changing needs of our members. This is what makes Fallon more than a health plan. And it’s why we feel our offerings for 2023 will be competitive and our existing members will choose to keep their Fallon plans. 

As you make your final preparations for AEP, we are here to answer your questions and provide any assistance you need. Please call our Broker Relations team at 1-844-848-4931 (TRS 711), Monday–Friday, 8:30 a.m.–5:00 p.m., or send them an email at MedicareSalesBrokers@fallonhealth.org.

Sincerely,

Deb Daviau

VP of Medicare and Executive Director of NaviCare^®

Please join us in welcoming Sandra Villalba as Fallon Health’s new Director of Medicare Sales for our Fallon Medicare Plus^™ product. Many of you may already know Sandra, who has more than 15 years of experience with Medicare. She joined our team on Sept. 12, 2022.

If you have any groups eligible for an employer group waiver plan (EGWP), Fallon has you covered—and at the same rates as 2022.

Fallon Medicare Plus Premier HMO is our Medicare Advantage EGWP plan that offers two provider networks—one includes a tailored selection of providers based in Worcester County, the other includes thousands of providers across Massachusetts. Your clients choose a plan based on the network doctors they want to see, what they want to pay, and the benefit allowance they need. 

The end of the calendar year will be here before we know it. If Fallon members have balances on their Benefit Bank card, Save Now card, and/or Healthy Food card, they can use them until Dec. 31, 2022. Balances on these cards do not carry over to the following year, and we want to make sure our members can use their benefits to the fullest. 

If your Fallon clients need balance information, here is where they can find it:

Benefit Bank card (Fallon Medicare Plus Orange, Green, and Blue plans; Fallon Medicare Plus Premier HMO; Fallon Medicare Plus Central Premier HMO)

• 1-800-325-5669 (TRS 711), Monday–Friday, 8 a.m.–8 p.m.
• MyFallon member portal: members.fallonhealth.org

Save Now card (NaviCare)

• 1-888-682-2400 (TTY 711), 24 hours a day, seven days a week
• myotccard.com

Healthy Food card (NaviCare)

• 1-888-983-8983 (TTY 711), 24 hours a day, seven days a week
• healthyfoodcard.com

With AEP upon us, here is a reminder of important changes to a CMS rule. Beginning Oct. 1, 2022, independent agents/brokers and other third-party organizations are required to: 

1. Record all calls with beneficiaries in their entirety. It was already required that telephonic enrollments be recorded. Now, the rule expands to include all calls.  

2. Include the disclaimer shown below in all of these ways/places:

• Verbally conveyed within the first minute of a sales call
• Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication 
• Prominently displayed on your website
• In any marketing materials, including print materials and television advertisements, that are developed, used, or distributed by you or a third-party organization

• This disclaimer must be used verbatim: “We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.” 

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. 

For more information, please contact our Medicare support team at MedicareSalesBrokers@fallonhealth.org.

Our easy-to-reach Broker Relations team is available to you at every stage of the sales process. We can provide you with personalized support over the phone Monday–Friday, 8:30 a.m.–5:00 p.m.