You pay both a copay and a deductible for some services. For details, see your plan’s Schedule of Benefits at mass.gov/gic. Prescription drug (Rx) benefits are included in the out-of pocket maximums for all health insurance products.
What You Need to Know
(Non-Medicare Plan Participants Only)
GIC protects you from balance billing under Massachusetts General Law Chapter 32A, §20.
If you receive covered, medically necessary medical care in Massachusetts, doctors, hospitals, and other medical providers may only collect the amount covered by your GIC plan. You are still responsible for your share of the plan’s copays, deductibles, and any other eligible medical out-of-pocket costs, but not any excess.
Always compare bills to the Explanation of Benefits (EOB) statement provided by your GIC health carrier. If you are not sure your invoice is a balance bill, call your health carrier. If it is a balance bill, advise your provider that as a GIC member, you are not liable for their excess compensation. If your provider persists in efforts to collect, contact the Group Insurance Commission.
Avoid the Retail Refill Penalty!
If you or a family member is taking a long-term medication—such as for high cholesterol or high blood pressure—you will receive a letter from Express Scripts asking you to tell them how you wish to receive your future refills—by mail or at your local CVS pharmacy.
If you choose to have your medication delivered to your home, your copay is lower. You can still pick up your medication at your local CVS pharmacy, but you’ll pay a higher copay*.
Make sure you respond to that letter from Express Scripts before your third refill, or you will be charged a significant penalty.
*If you choose the Express Scripts Pharmacy or a CVS™ pharmacy, you will pay one mail order copay for a 90-day supply of medication. If you use a non-CVS pharmacy, you will pay one retail copay for a 30-day supply of medication.