Coordination of Benefits – Harvard University Student Health Program

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What happens if I am enrolled on the Student Health Insurance Plan and another health plan?

The Student Health Insurance Plan is almost always the secondary payor when you are enrolled in two health plans. This means that claims will need to be submitted to your other health plan first before being submitted to the Student Health Insurance Plan, even if you know your primary plan will deny the services.

If you have more than one medical or dental plan, you are required to provide this information for your plans to work together, so your claims can be processed correctly and you can get the most out of your coverage. This process is referred to as Coordination of Benefits.

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 Massachusetts can retract payment on claims that should have been submitted to another insurance plan first. To avoid any claims issues, please notify your providers (doctors, hospitals, labs, etc.) of both plans. Please contact Blue Cross Blue Shield 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	MRI
Amount Charged	$1,700
Primary Plan Pays (HMO of CA)	$0*
Secondary Plan Pays (Student Health Insurance Plan – SHIP)	$950
Student Health Insurance Plan (SHIP) Member Liability	$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 (Harvard University Student Health Insurance Plan). 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.