Plan Options & Use | Steward Health Care

Plan Options & Use

Choosing A Plan

Steward Community Care is a partnership with Fallon Community Health Plan and Steward Health Care System. For more information visit the website or call Fallon Health at 800-868-5200.

Steward Community Choice is a partnership with Tufts Health Plan. For more information visit the website or contact Tufts Health Plan at 617-972-9400.

Using the Plan

Select a Steward Primary Care Physician and other Providers
Plan members must first select a primary care physician (PCP) from Steward’s network of providers. To find an in-network Steward provider, members can search online at DoctorFinder or call 800-488-5959. A representative will be available to help you choose a provider and, in some instances, book an appointment for you. Pediatric care is provided by Steward Health Care Network pediatricians and the Partners Health Care pediatric network, Affiliated Pediatric Providers (APP).

While most services can be provided within the Steward Health Care Network, in instances where services are not available, Steward has contracted with Massachusetts General Hospital and Brigham and Women’s Hospital to provide medically necessary care. If out-of-network care is required, your PCP must complete a standard insurance referral and obtain authorization from a Steward referral coordinator. If you have any questions, please contact a Steward referral coordinator at 855-295-4441.

Referrals
Referrals are required for most specialty services. If you do not obtain a PCP referral prior to your visit, you may be responsible for 100 percent of the claim. This will NOT accrue toward your out-of-pocket maximum. Referrals to all specialists are required except for certain services such as:

  • Emergency care received in an emergency room
  • Maternity care
  • Routine gynecological exams and medically necessary follow-up care
  • Evaluations and related services for acute or emergency gynecological conditions
  • Breast cancer screenings
  • Routine eye exams
  • Spinal manipulation

If you have any questions related to referrals, please contact a Steward referral coordinator at 855-295-4441.

For additional information, visit:

Fallon Health
800-868-5200

Tufts Health Plan
617-972-9400