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 plans’ allowed amount, you will be responsible for the difference between the two amounts.
The portion of eligible expenses that plan members are responsible for paying, most often after reaching a deductible. An example of coinsurance could be that your health plan covers 70% of covered medical charges and you are responsible for the remaining 30 percent.
The amount that you must pay for (certain) covered services. Your copayment is usually a fixed dollar amount.
Services or supplies for which your health plan will pay (or “cover”) all or a portion of the cost. Most health plans do not cover all services and supplies, and it is important to be aware of any limitations and restrictions that apply to your covered services.
The amount that you must pay before benefits are provided for (certain) covered services.
Specific conditions or circumstances for which a health plan will not provide benefits.
Medically Necessary Services
Services or supplies which are appropriate and necessary for the symptoms, diagnosis, or treatment of a medical condition, and which meet additional guidelines pertaining to necessary provision of medical or mental health care. Services must be medically necessary in order to be covered.
A group of physicians, hospitals, and other health care providers who participate in a specific managed care plan. When you receive care from an in-network provider, you pay only a copayment for covered services.
Physicians, hospitals, and other health care providers who do not participate in your plan’s network. Services obtained from an out-of-network provider are subject to deductibles and coinsurance.
When the deductible and coinsurance amounts you have paid in a plan year add up to the out-of-pocket maximum, the health plan will begin covering 100% of eligible charges for the remainder of the year.
The time period your health plan provides coverage. The HUSHP plan year is August 1 - July 31.
Preferred Provider Organization (PPO)
A type of insurance product that combines in-network and out-of-network coverage. When you use in-network (or “participating”) physicians and hospitals, you pay only a copayment for covered services. You also have the flexibility to see out-of-network (“non-participating”) providers, but you will be responsible for a deductible and coinsurance for inpatient and outpatient covered services. The Harvard Student Health Insurance Plan is a PPO plan.
A pre-existing condition is a health condition that existed prior to your application for a health insurance policy or enrollment on a new health plan. Examples of pre-existing conditions include pregnancy, heart disease, high blood pressure, cancer, diabetes, and asthma. HUSHP does not impose pre-existing condition clauses or exclusions.
Usual and Customary Fee/Allowed Amount
The common cost of a specific medical service; this fee can be lower than what a physician charges and is based on a variety of criteria including provider type and service region.
Health care reform
The Affordable Care Act (ACA) creates new health insurance options for students. Most Harvard students already participate in the Harvard University Student Health Program (HUSHP) -- which meets all ACA requirements.
If you consider one of the new ACA plans, be sure that you make an informed decision. You will need comparable coverage to begin by February 1, 2015 in order to waive enrollment in HUSHP. Some important things to consider are:
- Access to doctors in the Cambridge/Boston area
- Benefits and coverage
- Out-of-pocket costs
- Coverage while traveling (in the U.S. and abroad)
Massachusetts and Federal Health Insurance Information
Other Resources to Help You Make an Informed Decision
The Affordable Care Act: Options for Students
Learn more about insurance options available to students under the Affordable Care Act.
Health Insurance FAQs
Click for a list of common questions and answers regarding the Affordable Care Act, HUSHP, the Massachusetts Health Connector, and HealthCare.gov
Sample Health Plan Comparison Chart
Use this chart to learn about some of the important coverage options you should consider when comparing health insurance plans. Please note that premiums can vary dramatically and the chart does net include all factors that you should consider when selecting health insurance coverage. Learn more about HUSHP coverage and benefits or visit MAhealthconnector.org or HealthCare.gov for detailed information about your insurance options.
Sample Costs for a Knee Injury
This chart compares the potential costs for treating a knee injury depending on your insurance coverage, and is for illustrative purposes only. Consult your insurance plan for information about your specific coverage.
How SHIP works with another health insurance plan
When you are enrolled in the Student Health Insurance Plan (SHIP) and another health insurance plan, the SHIP is always a secondary payer. This means that all claims are processed first through your other insurance and then processed by the SHIP. 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.