Your health insurance benefits will need to be coordinated if:
- You are enrolled on the Student Health Insurance Plan and any other health plan. Examples of other insurance could include a parent’s plan, a spouse’s plan, and/or a government-sponsored plan like Medicare or Medicaid.
- A dependent is enrolled on the Student Health Insurance Plan and enrolled on another health plan.
- You receive care as the result of an automobile accident or an injury that occurred at work.
Blue Cross Blue Shield of MA can retract payment on claims that should have been submitted to another health insurance plan first. To avoid any claims issues, please notify your providers of both plans. Please contact BCBS Coordination of Benefits at (888) 799-1888 for more information.
Example of how Coordination of Benefits works:
Erika is scheduled for an MRI at a low-cost share facility in Boston. She’s enrolled on her parent’s health plan in addition to the Student Health Insurance Plan. Her parent’s plan is an HMO based out of California. Her California health plan does not cover planned care out-of-state.
Even though Erika’s primary insurance (HMO of California) will not cover the MRI in Boston, the MRI still needs to get billed to her parent’s plan first.
| Service | Amount Charged | Primary Plan Pays (HMO of CA) |
Secondary Plan Pays Contracted Rate (SHIP) |
SHIP Member Liability |
|---|---|---|---|---|
| MRI | $1,700 | $0* | $950 | $50 |
|
*Erika’s primary plan does not cover planned care outside of MA. Because of this, they did not pay any portion of the costs. After receiving the denial, her provider submitted the charges to her secondary plan (SHIP). Her secondary plan paid the contracted rate for the services and she was left liable for her copayment. If the claim was submitted to her secondary plan first and her secondary plan incorrectly paid the charges, they can retract their initial payment on the claim. The provider would send Erika the bill for the full charges. |
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