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Coverage Highlights
Note: The Student Health Insurance Plan covers routine preventive medical exams for a member who is age 18 or older. Routine preventive medical care is also covered at Harvard University Health Services by the Student Health Fee.
Frequently Asked Questions
What is the difference between in-network and out-of-network care?
In most cases, you receive the highest level of benefits when you choose a provider in the BCBAMA “PPO network with Hospital Choice Cost Sharing.” These are called your “in-network” benefits.
When you seek care from an out-of-network provider, you will pay more for your care. For most out-of-network services, you must first pay a plan-year deductible; then you pay a coinsurance. Your out-of-network provider may bill you for the difference between their charge for services and the amount that Blue Cross Blue Shield (BCBS) pays for those services. This is known as balance billing.
The allowed amount is the maximum amount that the plan (Blue Cross Blue Shield) will pay for a covered service. If you use your out-of-network benefits and file for reimbursement, you will be reimbursed based on the allowed amount (minus your deductible and coinsurance) and NOT what the provider charges for the service. If your provider charged more than the plan’s allowed amount, you will be responsible for the difference between the two amounts.
Please see the example below for what your cost for care could look like if you see an out-of-network provider. All dollar amounts in this example are hypothetical and are for illustrative purposes only.
| In-network | Out-of-network | |
|---|---|---|
| Doctor’s charge for outpatient surgery | $50,000 | $50,000 |
| Blue Cross Blue Shield pays | Negotiated rate (because the provider is contracted with Blue Cross Blue Shield) | $15,000 (allowed amount) |
| Amount you owe | $75 at LCS Hospital; $250 at HCS Hospital (contracted provider does not balance bill member) | $35,000 (this includes your deductible, co-insurance, and balance billing) |
Note: Even if you met your deductible and out-of-pocket maximum for the plan year, you are still responsible for the doctor’s balance billing charges when using out-of-network providers. To save money, we encourage you to use in-network health care providers and lower cost-sharing hospitals in Massachusetts.
How do I locate network providers?
- Go to member.bluecrossma.com/fad and select “PPO network with Hospital Choice Cost Sharing” as your plan’s network for services or contact Member Services at mservices@huhs.harvard.edu or (617) 495-2008 for assistance.
- To locate a preferred provider out of state, please call Blue Cross Blue Shield Global Core at (800) 810-2583. Inform the representative that you are looking for a PPO network provider.
- Log into www.bluecrossma.org
- Under My Account click on Request a Written Cost Estimate.
- Blue Cross will respond to your request within two to four business days of receiving all required information.
- Estimate from the provider: All providers are now required to provide cost estimates for services they provide. Talk to your doctor about getting an estimate before you get services.
Note: When patients receive ancillary services (such as labs or durable medical equipment) from an in-network provider, those services may be billed at the out-of-network benefit if the ordering provider and the provider rendering care are located in different states. View the Handbook to learn more about how ancillary services are billed.
Do my copayments differ depending on where I go for care?
Acute care hospitals in Massachusetts are grouped into two different cost-sharing levels. When you choose hospitals that have met the Blue Cross Blue Shield quality benchmarks and are lower cost, you will pay less for your care; the amount you pay out-of-pocket for those services is based on that hospital’s cost-sharing level.
- Lower Cost Share Hospitals ($)—applies to hospitals that have met the quality benchmarks and are lower cost. Members pay less when they get care at these hospitals.
- Higher Cost Share Hospitals ($$)—applies to hospitals that have met the quality benchmarks and are higher cost. Members pay more when they get care at these hospitals.
- Inpatient admissions
- Outpatient day surgery
- Outpatient diagnostic high-tech radiology (CT Scans, MRI, PET scans, and nuclear cardiac imaging)
| In-network: your cost at lower cost sharing hospitals | In network: your cost at higher cost sharing hospitals | |
|---|---|---|
| Inpatient admission | $100 copay | $500 copay |
| Outpatient day surgery | $75 copay | $250 copay |
| Outpatient diagnostic high-tech radiology | $50 copay | $125 copay |
Need help finding a lower cost sharing hospital? The Find a Doctor tool, located at bluecrossma.com/findadoctor, is available 24/7 with up-to-date provider selection support and the ability to find a lower cost share hospital or provider. Select “PPO Network with Hospital Choice Cost Sharing Feature” from the “My Health Plan” dropdown.
Remember: The higher cost sharing does not apply to emergency room services, so you should always go to the nearest hospital in an emergency.
What happens if I am enrolled on the Student Health Insurance Plan and another health insurance?
When you are enrolled in the Student Health Insurance Plan and another health insurance carrier, the Student Health Insurance Plan is always a secondary payer. This means that all claims are processed first through your other insurance and then processed by the Student Health Insurance Plan. 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.
