Benefits effective August 1, 2016 and are subject to change.

Benefit Type AY16 Benefit AY17 Benefit

Routine exams and preventive care
Pediatric (through age 17 only)

$35 copayment
Visit limits apply

$0 copayment
No visit limit

Clinic and physician's office visits: diagnostic/specialist
Pediatric (through age 17 only)
$35 copayment
10 visit limit

Harvard Vanguard: $0 copayment
No visit limit

All other in-network providers: $35 copayment
10 visit limit

Emergency room $50 copayment $100 copayment
Prescription drug

Tier 1: $12 copayment
Tier 2: $35 copayment
Tier 3: $50 copayment

Tier 1: $17 copayment
Tier 2: $40 copayment
Tier 3: $55 copayment
Hi-tech imaging
Outpatient advanced imaging tests (CT scans, MRIs, PET scans, nuclear cardiac imaging)
$0 copayment $50 copayment
Outpatient surgery $50 copayment $75 copayment
Inpatient admission $0 $100 copayment

 

Policy Name AY16 Policy AY17 Policy

Dependent Eligibility

Marriage certificate or certified same-sex domestic partnership

Marriage certificate required for spouse enrollment

Fall Term HUSHP Enrollment
Deadline for student dependents, affiliates, and affiliate dependents

September 30 August 31