Coverage for GIC members | Mass General Brigham Health Plan

2022 virtual health fair kit
Get to know Mass General Brigham Health Plan. Highlights from our virtual health fair kit with information about:
- About our Complete HMO for GIC members - highlights of the value we offer
- How we tier – we keep it simple with just two tiers
- Help in finding a doctor – tips when using our online directory
- Covered preventive services – know what's covered at no cost
Download the virtual health fair kit in one handy PDF.
Support in transition of care

If you’re currently receiving care for a certain condition, have plans to see a specialist later this summer, or need prescriptions that require authorization (including for infusions or durable medical equipment), we can help ensure you continue to receive care as you join us.

Let us know as soon as possible if you or a family member have care that needs to continue with your new plan by completing and sending the Transition of Care form to us by email, mail or fax. You can also call us at 866-567-9175 (TTY users call 711).

Benefit	Cost sharing
Medical Deductible	$500/$1,000
Maximum Out-of-Pocket (includes medical, pharmacy, and behavioral health)	$5,000/$10,000
Primary Care Provider Office Visit Copay	$20
Specialist Office Visit Copay	$30/$60
Emergency Room (emergency care covered at any hospital emergency room)	$100 and then deductible
Inpatient Medical Care	$275 and then deductible
Outpatient Surgery at a Freestanding Ambulatory Care Center (for non-preventive colonoscopies, endoscopies, and eye surgeries)	$150 copayment and then deductible
Outpatient Surgery (plus hospital based non-preventive colonoscopies, endoscopies, and eye surgeries)	$250 and then deductible
High-tech Imaging	$100/scan and then deductible
Virtual Urgent Care / On Demand	$15
Telemedicine through PCP or Specialist	$15 or $30/$60
Telemedicine for Mental Health Care or Substance Use Care copay	$0 member cost sharing for first three visits, then $15

Benefit information good through June 30, 2022

*Benefits must be received by a participating provider unless otherwise indicated

Current plan details and member handbook

Schedule of Benefits

Download current Schedule of Benefits (PDF)

Summary of Benefits and Coverage

Download current Summary of Benefits and Coverage (PDF)

Member handbook

Download current member handbook (PDF)
Secure member portal

Log in to your portal at Member.MassGeneralBrighamHealthPlan.org to get complete details about current coverage, benefits, and more.

Mass General Brigham Health Plan for the GIC