Student Insurance Plans and Health Care Coverage Wednesday, August 12 at noon (EDT)

Transcription

1 Student Insurance Plans and Health Care Coverage Wednesday, August 12 at noon (EDT) Participants spoke with representatives of the MIT Health Plans about the student extended insurance waiver form, what's covered under the basic student medical plan, how health insurance might work when a student is away from home, and other coverage questions. pre-submitted (Q) pre-submitted (Q) Dear parents: On behalf of the MIT Parents Association, I d like to thank you for joining us for this hour-long chat with representatives from MIT Medical. I believe we are ready to begin! First, a few notes about the question and answer process: Questions will appear in the chat dialogue along with their answers. Any questions that we re not able to get to in this time period will be answered after the chat. These questions and answers will be published along with the transcript of this chat at the end of the week on the Parents Association Web site. Now, I m pleased to introduce Kim Schive, the communications coordinator for MIT Medical. Hi, I'm Kim Schive, MIT Medical's communications coordinator, and I'm going to be moderating today's discussion, which will focus on insurance coverage for MIT students. With me today are Lucy Walsh, MIT Health Plans Manager, and Sara Fuschetto, MIT Health Plans Enrollment Administrator. Some of you submitted questions in advance; those questions will be identified when we post them during today's chat. Of course, we're also looking forward to answering your "live" questions. When you type a question during today's chat, it will first come to me, and then I'll direct it to either Lucy or Sara. If you have a question in mind, feel free to start typing and submit it at any time! Today's discussion is intended for general questions about insurance coverage. We can't discuss very specific individual situations in this forum, but we will be happy to answer those questions privately. Let's begin with one of our pre-submitted questions. Is an eye exam or new eyeglasses covered at all? If not, what would a typical eye exam cost? Routine eye exams (one per 12-month period) are covered under the Student Extended Insurance Plan only, and only when provided at MIT Medical. Discounts on eye glasses are available to all students through the MIT Optical Shop located in the Student Center. Contact lenses are available for purchase at competitive prices, no additional discounts. Without the Extended Insurance Plan, an eye exam at MIT Medical will cost, on average, $125. We have BCBS Florida PPO, and we want to make sure our daughter will get coverage in Boston. Can you tell us if, or

2 why, we would need additional student health insurance? You need to contact your insurance company to obtain a list of local, in-network providers in the Boston/Cambridge area. Make sure to look at mental health facilities as well as other hospitals and physicians. Once you have the list, you need to assess the availability of in-network providers, as well as the out-of-pocket expenses under your plan to determine if the plan meets the state coverage requirements. Details on these requirements are available on the MIT Medical website ( But, just as important as coverage issues is your child's ability to navigate the health care system. If she is enrolled in the Extended Plan, our clinicians and staff can assist her in obtaining needed medical services outside of MIT Medical. However, if your child only has your insurance, she will be responsible for verifying whether outside providers are innetwork or not. She'll also need to know if referrals or authorizations are needed. pre-submitted (Q) There's also a convenience factor. For example, our MIT Pharmacy doesn't participate in all the pharmacy programs of other insurance carriers, so your daughter may not have coverage for prescriptions filled at the MIT Pharmacy and will need to go to an outside retail pharmacy to fill prescriptions. If your daughter waives the Student Extended Insurance Plan, please make sure that she carries her own insurance card with her at all times. Hi, I have decided to arrange for my child (a sophomore) to have the MIT insurance in addition to keeping her on my own plan. Will she receive a detailed explanation of services in booklet form in the near future so we can understand and reference how MIT may supplement our outside plan? To keep costs down, we only mail brochures to new students. However, you can download the brochure at the MIT Medical website ( or stop by the MIT Health Plans office to pick one up. The office is on the 3rd floor of MIT Medical (building E23). If you have specific coverage questions, you or your child can stop by the Claims & Member Services office on the first floor of MIT Medical, near the Pharmacy. We also hold a number of student orientations during the year, many in Sept. During these orientations, we provide an overview of MIT Medical and the services available, the insurance options, and the waiver deadline. And we always come with copies of the brochures.

3 Blanche(Q) epark(q) akefeli(q) pre-submitted (Q) I'm just curious... about what percent of the MIT student body takes the MIT insurance plan? I've heard it is a lot, maybe percent. Is this right? I can answer this one... It's about 70 percent of the total student body, including grad students. What is covered under the basic student medical plan? And does our health insurance act as a supplement to the basic student medical plan, or the other way around? The cost of the basic student medical plan is included in the tuition fee. This covers most services provided at MIT Medical. The Extended Insurance Plan provides additional coverage for some services here, but mostly for outside services, such as emergency room care, inpatient care, and pharmacy coverage. Hi: I was working on the waiver form and i was asked for the certificate. What is that? BTW, who should do the medical waiver form, student or parent. Hi, The student should waive the MIT Student Extended Insurance Plan as the student has their own unique "Kerberos" certificate (the certificate actually acts as their signature). The waiver link is Students should make sure they receive the automatically generated that confirms their waiver. This is the only receipt of their transaction. Please note that the waiver deadline is September 30, Is there a charge for MIT student basic plan? The cost is included in tuition. I have horizon insurance and the insurance company said my plan is very, very good, so I plan not to buy the extended med insurance. What does my daughter do if she needs to see a doctor? -- Mimi Your daughter can see any of our physicians here at MIT Medical under the basic health plan (included as part of her tuition) but if she needs to see an outside physician she needs to know the rules of her own insurance plan, such as referral requirements and whether providers are in-network or not. I want to know about shots and vaccinations. Are booster shots covered (for example, tetanus)? Flu shots, including the new swine flu shot, are covered, right? Many routine vaccinations are covered as part of the basic MIT Student Medical Plan; others are covered under the Student Extended Insurance Plan. Some have a $20 copay.

4 tjman(q) Prematriculation immunizations (those required for college admission) are not covered, but other vaccines are covered under the basic Student Medical Plan. Some are provided at no additional cost, such as the seasonal flu vaccine or a tetanus booster. Others have a $20 copay, such as hepatitis A or B or rabies. Gardasil is covered under the Extended Plan only, with a $20 copay for each of the 3 shots. We expect that the new swine flu vaccine will be provided at no additional cost, but we do not know for sure yet, because it is not yet available. In order to be covered, any vaccine must be provided by MIT Medical. Our student has received medical care at MIT Medical several times. We have not received any bills. At what point will our family insurance have to pay? Most services provided at MIT Medical are covered under the basic health plan, included as part of tuition. So your child would not be billed for those services. As grad students they will have to take the MIT Extended Plan isn't it? Like undergrads, grad students have to take the Extended Plan unless they have equivalent coverage and can waive. Many grad students (though not all) have RA-ships that cover the cost of the Extended Plan. Do you have a list says what is covered under the MIT basic plan? It s a pretty comprehensive list of services provided here at MIT Medical. The best place to view the list is through our brochure, available on-line at medweb.mit.edu/healthplans/student, or you can pick up a brochure in the Health Plan office. Can you comment on the dental coverage, if any? We do not have dental coverage included in the MIT Student Health Plan. If you wish to find more details about this, please see the explanation of coverage at Do you encourage students to get flu vaccinations? This is really more of a medical question for our next chat on August 19th, but the short answer is "yes." We have special flu-shot clinics in the fall to try to get as many students vaccinated as possible. And, just to make this answer insurance related, I'll add that the seasonal flu shot is covered in full under the basic Student Medical Plan. When my kid needs medical help, where does she go? When

5 epark(q) Young(Q) does she use the basic insurance; when does she use my insurance? For most services, she can see a doctor on site. She can call to schedule an appointment, or come in to Urgent Care, which is open 24 hours a day during the academic year. If she needs specialty services, not available here, she will need to use her own insurance and contact the outside provider directly. Our clinicians can recommend local providers based on her needs, but she will need to verify that the provider is participating with your insurance. Are the physicians providing services under the basic plan general internists? Are there any specialists? Most services provided at MIT Medical, including specialties, are covered under the basic Student Medical Plan. Exceptions are pharmacy services and OB (though GYN is covered). You can see a list of all our services, including specialties, on the MIT Medical website at Is a student covered during the summer while working on a UROP for example? If they are here this summer, prior to their Freshman year, they would need to speak to their specific program. Some do offer our insurance for their participants. If they are here during the summers following their Spring academic semester, their coverage continues through August 31. The Fall insurance coverage is for September 1 through January 31, then the Spring term picks up for February 1 through August 31. If a student falls and breaks a leg and is taken to an emergency room by an ambulance, does the basic student medical plan cover the cost? If the fall occurs on campus, we have a student run ambulance service (staffed by trained EMTs) which would transport them to our Urgent Care Service here at MIT Medical. If we transfer them to the hospital that would also be covered. There is also coverage for independent ambulance transport, up to $350 per day for ground transport. [Editor's note: Ambulance coverage was recently increased from $350 per day to $1,200 per day for medically necessary ground transport. Unfortunately, that change is not reflected in this year's brochure.] Is the waiver signed in September valid for the whole academic year? Yes, as long as the student selects BOTH semesters when

6 janice(q) janice(q) janice(c) cathy(q) Young(Q) submitting the waiver in September. So, if a student is home for the summer, how does she/he get coverage under the extended plan? Students registered for the entire academic year need not do anything if they wish to maintain coverage throughout the summer. The fall term is 9/1/09 to 1/31/10, and the spring term is 2/1/10 to 8/31/10. So summer is included within the registered spring term. Janice, are you asking about coverage, or are you asking about getting services during the summer? Thanks, Sara, but if she's out of Boston for the summer, is she considered "out-of-network" and does she submit some kind of paperwork to get reimbursement for any medical needs taken care of here (DC area)? The Extended Insurance Plan is a Blue Cross PPO. If your daughter goes to a participating BCBS provider in your area, the services will be covered as "in network." In addition, there is out-of-network coverage available. We don't have any questions waiting at this point. Does anyone else have questions now about insurance coverage? This is your chance to jump to the front of the line! Okay, we have a couple questions in the queue now, but please feel free to jump in with more. We're working on answering these... Thank you for holding this online chat. It's very helpful! I'm a bit late in joining; sorry I missed the earlier questions. My daughter has a couple relatively complicated issues with TMJ and deviated septum. Would things like this be covered by MIT medical? There is very little coverage for TMJ, although a consult with an oral surgeon would be covered. There are benefits for physical therapy and some appliances, but I do not know your daughter s specific needs for TMJ. As with any insurance carrier, our coverage for deviated septum would be based on medical necessity, so it is difficult to determine coverage without clinical assessment. This might be best addressed by talking to one of our Claims & Member Services staff at Are there any pharmacies other than MIT Pharmacy near campus? There are pharmacies near Central Square, which is one "T" stop away. However, students with the Extended Plan should try to fill their prescriptions at the MIT Pharmacy located on

7 mitmed_lucy_walsh(p) Jerilyn_Lewis(Q) Young(Q) jm(q) campus in order to receive the lowest price. If my insurance allows a kid to go to Walgreen's or, Rite Aid for prescriptions, is there any near by? There are no Rite Aids that we can think of, but there's a Walgreen's in Central Square, which is one subway stop from Kendall. It's also within fairly reasonable walking distance. Oops... hold the presses. Someone just Googled Rite Aid and says there's a Rite Aid in Cambridgeport... a bit further than the Walgreen's. We filed out form called "Welcome from MIT Medical." Are there any more forms to fill? Do you mean the medical report? Okay, that's the form required for students to enroll. It has nothing to do with insurance. Mimi, the Medical Record report is for immunization requirements. You will still need to complete the waiver form online if you intend to waive the extended insurance. Is there any medical form she has to fill out other than the waiver form? Not that we know of, but this might be a question to ask in the general medical discussion next Wednesday (Aug. 19). I have a question about the medical waiver. My medical coverage is by calendar year, so if my son did the waiver in Jan 2009, he is still under the same coverage in September. Do I have to do the waiver again? Yes, our student insurance is by term. So he must waive each academic year to demonstrate that he is still covered under the outside insurance. He can waive in September for the entire academic year. To make sure I understand...does the MIT Pharmacy located on campus cover only the MIT Extended Medical Plan but not other prescription plans? The MIT Pharmacy participates with most ExpressScripts coverages, but not most other pharmacy programs. You or child can ask the staff in the pharmacy about your specific pharmacy coverage. The pharmacy can be reached at Okay, we're working on one last question now. We'll get that answer up before closing the chat. We plan to waive the extended insurance, but my policy may change (changing jobs). Is it possible to waive extended insurance initially, and then enroll later in the term?

8 tjman(c) mitmed_lucy_walsh(p) fbuczyk(c) Hi - yes, this is possible. Just make sure your prior insurance issues you a termination form that details the end date of your coverage. Have the student bring this to our office at E so we can ensure unbroken coverage. Thanks for hosting this forum; it was very helpful. Thank you everyone for participating. Good luck to all of your students. Thank you very much! Our hour is up! Thanks again for joining us, everyone. We look forward to seeing many of you again next Wednesday, August 19, at noon EDT for our chat on the topic of Student Medical and Mental Health Care at MIT.