Hospital Choice Cost Share (HCCS)

• This only applies to those on the co-pay based plan and getting services at one of the select hospitals in Massachusetts.
• Select hospitals in Massachusetts will have higher out-of-pocket costs when receiving services. If you select to go to a HCCS hospital, certain services will have a co-pay after the deductible is met. (At other hospitals these services are covered in full by the plan once the deductible is met).
• The costs for in-network services are:
  • In-patient hospitalization and out-patient surgery: $1,000 after deductible
  • Physical, occupational and speech therapy: $50 after deductible
  • Diagnostic X-ray: $100 after deductible
  • Laboratory testing: $35 after deductible
  • MRI, CT, PET scans: $450 after deductible
• As a reminder, this change only affects those who will be on the co-pay plan and getting services at these select hospitals.