Blue Cross Blue Shield coverage includes, but is not limited to:
|Ambulatory Surgery||Mental Health Care Outside HUHS|
|Diagnostic Lab/Radiology Services||Pediatrics|
|Emergency Room Visits||Obstetrics/Gynecology|
|Hospitalizations||Specialty Care Outside HUHS (Limited)|
|Maternity Care||Dental (members under the age of 19)|
Note: The Student Health Insurance Plan does not cover routine preventive medical exams for a member who is age 18 or older. Routine preventive medical care is covered at Harvard University Health Services by the Student Health Fee.
Prescription Drug Coverage
The Student Health Insurance Plan’s prescription drug coverage may be used on campus at the HUHS Pharmacy or at most retail pharmacies. For copay/coinsurance information, please review the Prescription Drug Plan Summary.
Understanding the Student Health Insurance Plan
Harvard University Health Services is committed to offering robust health insurance coverage to Harvard students and their families. The Student Health Insurance Plan provides a more comprehensive set of benefits, at a better price, than comparable unsubsidized plans available via the Massachusetts Health Connector. The plan is also competitively priced and provides a rich mix of benefits relative to peer institutions.
Harvard University Health Services conducts annual reviews of the Student Health Insurance Plan benefits, medical and prescription claims, and utilization of services. This detailed analysis provides information on how to best align the plan’s benefits with the needs of the student population.
External factors in the healthcare market, such as varying prescription drug pricing and shifting physician and hospital reimbursement rates, continue to impact both commercial health insurance plans and individual student health insurance plans. As a result, the premiums reflect a thoughtful analysis of the plan benefits, the increase in medical and prescription drug costs, and the benefit utilization by students and their dependents. Premium adjustments are made on the basis of actual plan costs from previous years.
Benefits Comparison Chart
Health Connector plans
|Out of network benefit||Yes, this is a PPO plan||No, this is an HMO plan|
|Inpatient admissions||$100 copay*||$500 copay|
|Advanced imaging||$50 copay*||$150 copay|
|Emergency room||$100 copay||$150 copay|
* Depends on hospital selection; see plan for complete details.
In-Network vs. Out-of-Network
In most cases, you receive the highest level of benefits when you choose a preferred provider in the "PPO network with Hospital Choice Cost Sharing" feature. These are called your “in-network” benefits.
When you seek care from an out-of-network provider, your out-of-pocket costs will be higher. 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 his/her charge for services and the allowed 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.
Example: The high cost of going out-of-network
All dollar amounts in this example are hypothetical and are for illustrative purposes only.
|Blue Cross Blue Shield pays||Negotiated rate
(because the provider is contracted with Blue Cross Blue Shield)
|$50,000 (allowed amount)|
|Amount you owe||Applicable copayment
(contracted provider does not balance bill member)
(this includes your deductible, co-insurance, and balance billing)
Note: Even if you have 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.
To find a doctor or hospital in your network:
- Go to bluecrossma.com/findadoctor and select “PPO network with Hospital Choice Cost Sharing” as your plan’s network for services on or after August 1, 2017 or contact Member Services at firstname.lastname@example.org 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.
To understand what your costs may be if you choose an out-of-network provider, you can always ask for a written cost estimate.
- Log into bluecrossma.com/myblue
- 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.
Primary vs. Secondary 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.
Hospital Choice Cost Sharing
With Hospital Choice Cost Sharing, the choice is yours. As a Student Health Insurance Plan member, you are empowered to control your own out-of-pocket costs based on the hospital you choose for care.
How It Works
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.
Hospital Cost Sharing applies to the three benefit services below:
• Inpatient admissions
• Outpatient day surgery
• Outpatient diagnostic high-tech radiology (CT Scans, MRI, PET scans, and nuclear cardiac imaging)
Example of your out-of-pocket costs when selecting a cost sharing hospital for certain services:
your cost at higher cost sharing hospitals
|$100 copay||$500 copay||30% co-insurance|
|Outpatient day surgery||$75 copay||$250 copay||30% co-insurance|
Outpatient diagnostic high-tech radiology
|$50 copay||$125 copay||30% co-insurance|
|Emergency room||$100 copay||$100 copay||$100 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” drop down.
- Your out-of-pocket costs will be higher when you get care at a higher cost share hospital for inpatient admissions, outpatient day surgery, and outpatient diagnostic high-tech radiology services.
- You can search for lower and higher cost share hospitals online by selecting “PPO Network with Hospital Choice Cost Sharing Feature” as your plan’s network.
- The higher cost sharing does not apply to emergency room services, so you should always go to the nearest hospital in an emergency.
Telehealth is a video consultation with a medical and/or behavioral health clinician. You can connect with a board-certified doctor in minutes, using a smartphone, tablet, or computer. Providers are accessible 24 hours a day, 7 days a week, 365 days a year for non-emergency care through American Well, a leading Telehealth provider. Some of your current providers may be participating in Telehealth; check with your provider to see if they are participating. Telemedicine visits would follow the same cost-sharing rules and visit limits that other office visits have. Routine medical care is not covered under this benefit. Your provider must be contracted with American Well or BCBSMA to provide these services to you. The plan does not cover video visits if the provider is not contracted by the plan to offer these services. Learn more about your telehealth benefit.
How will Telehealth visits be covered?
As long as you use a network Telehealth provider, your appointments would be covered with applicable office visit copay and will be subject to any physician office visit limits. First time users should enter Service Key: BCBSMA when you register on the Am Well Live Doctor Video Visits app. You may be asked to provide your credit card number to pay for your copay, just as you would at a doctor’s office.
What types of services are available via Telehealth?
· Behavioral health visits
· Medical visits to diagnose conditions like sprained ankle, sore throat, bronchitis
Students enrolled in a comparable health insurance plan may be eligible to waive the Student Health Insurance Plan. Waivers must be completed by the appropriate deadline or the charges will remain on your student bill.
How to find a provider
You have access to “Blue Care Elect PPO” providers within the Blue Cross Blue Shield network.
- Visit the Blue Cross Blue Shield website
- Search for a provider by name, specialty, or location
- Select Blue Care Elect PPO/EPO from the network dropdown (for in-network benefits)
- When searching for a provider in Massachusetts you should select "PPO Network with Hospital Choice Cost Sharing Feature" from the "My Health Plan" drop down menu to ensure the lowest out-of-pocket costs if you are receiving inpatient care, outpatient day surgery, outpatient diagnostic high-tech radiology (CT scans, MRI, PET scans or nuclear cardiac imaging)
You will have higher out of pocket costs if you choose to see an out-of-network provider. Contact HUSHP Member Services at (617) 495-2008 or Blue Cross Blue Shield of Massachusetts at 1 (800) 257-8141 if you need assistance.
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.
Limitations and exclusions apply, so it is important to familiarize yourself with the Student Health Insurance Plan benefits prior to seeking routine care.
Disclaimer: All benefits are subject to medical necessity criteria. The benefits description defines the terms and conditions of your coverage, and will govern if questions arise. HUHS services are limited in scope and subject to change.