Health Plans 2017 2018 Overview In this book: Insurance plans and rates How to enroll or waive coverage Your medical benefits Commonly used terms Useful contact information 1
Insurance plans and rates Medical Plan All students who are registered at least three-quarters time are enrolled in this plan. The cost is included in your tuition. It covers most services provided at MIT Medical, our multispecialty, on-campus health center. This plan does not provide comprehensive coverage as required by state and federal law. Students must have additional insurance to meet state and federal requirements. You can enroll family members in the Student Medical Plan for an additional charge. Extended Insurance Plan This plan (also called the Extended Plan) complements the coverage provided by the Student Medical Plan and meets state and federal requirements for comprehensive coverage. It adds coverage for prescription drugs and off-campus services such as emergency room visits, surgical procedures, and inpatient hospital stays (including maternity care and inpatient mental health/substance abuse treatment). In order to enroll in the Student Extended Insurance Plan, your family members must also enroll in the Student Medical Plan. Cost of coverage for Fall term Sept. 1, 2017 Jan. 31, 2018 Spring term Feb. 1, 2018 Aug. 31, 2018 Medical Plan Just you (included in tuition) Extended Insurance Plan $1,250 You and your spouse / partner + $635 = $635 $1,250 + $720 = $1,970 You and your dependent(s) + $315 = $315 $1,250 + $115 = $1,365 You, your spouse / partner, and your dependent(s) + $635 + $315 = $950 $1,250 + $720 + $115 = $2,085 Both plans $1,250 $2,605 $1,680 $3,035 Medical Plan (included in tuition) Extended Insurance Plan $1,750 + $889 = $889 $1,750 + $1,008 = $2,758 + $441 = $441 $1,750 + $161 = $1,911 + $889 + $441 = $1,330 $1,750 + $1,008 + $161 = $2,919 Both plans $1,750 $3,647 $2,352 $4,249 } Note: Family members must enroll in the Student Medical Plan before you may purchase Student Extended Insurance Plan coverage for them. The separate Extended Plan rates are shown here for reference only. Both terms Sept. 1, 2017 Aug. 31, 2018 2 Medical Plan Extended Insurance Plan (included in tuition) $1,250 + $1,750 = $3,000 $635 + $889 = $1,524 $3,000 + $720 + $1,008 = $4,728 + $315 + $441 = $756 $3,000 + $115 + $161 = $3,276 + $950 + $1,330 = $2,280 $3,000 +$720 + $115 + $1,008 + $161 = $5,004 Both plans $3,000 $6,252 $4,032 $7,284
How do I enroll or waive coverage? Students Full-time students and students carrying registration loads of at least three-quarters time are automatically enrolled in both the Student Medical Plan and the Student Extended Insurance Plan. The cost of the Student Medical Plan is included with tuition. Charges for the Extended Plan are billed to your student account. Visiting students and students carrying registration loads between half time and three-quarters time are eligible to enroll in the Extended Plan, but enrollment is not automatic. To enroll, you must come to the Health Plans Office in E23-308. You can waive your Extended Plan coverage, but note: the Extended Plan covers benefits which are required by federal and state law and are not covered by the Student Medical Plan. All students must provide proof of comparable insurance coverage in order to waive the Extended Plan. If you want to waive and you have other coverage that meets Massachusetts requirements, you must complete the online waiver form at medical.mit.edu/waive before the waiver deadline. Waiver deadlines To waive coverage for The waiver form is due: the entire academic year* August 31, 2017 only the spring term January 31, 2018 only the summer term June 15, 2018 * During the waiver period for the fall term, you waive for the entire academic year. Before waiving, read the insurance FAQs at medical.mit.edu/faqs and be prepared to provide proof of comparable insurance coverage. You will be responsible for paying for the Extended Plan if you do not waive by the deadline or submit a request for a late waiver and pay the late fee. Late waiver requests will be accepted for 30 days after each waiver deadline, with a late waiver penalty of $150. Note: If you are covered by another comprehensive insurance plan in addition to the Extended Plan, your other plan will be the primary insurer. Family members Students may enroll spouses, partners or spousal equivalents, and dependents (children up to 26 years old) in the Student Medical Plan and the Student Extended Insurance Plan. To enroll in the Extended Plan, family members must also enroll in the Student Medical Plan. To enroll your family members, come to the Health Plans Office in E23-308 and bring proof of your family members eligibility for coverage. Proof of eligibility includes: A marriage certificate for you and your spouse. A signed Affidavit of Spousal Equivalent Partnership form for you and your spousal equivalent and proof that you are living together. You can get the form and examples of acceptable documentation at the Health Plans Office, or download them at medical.mit.edu/pdf/spousal.pdf. A birth certificate for your dependent child that shows the name of the child and the name of the parent, or a passport that shows the parent/child relationship. You can enroll family members for health insurance coverage during one of the enrollment periods listed below or within 30 days of a qualifying life event (see definition on page 7). If your family members arrive in the United States from another country after you, you will need to provide proof of the date they arrived, such as a stamped passport, visa, or airline ticket or boarding pass. Enrollment periods for family members For the fall term: July 3 August 31, 2017 (coverage begins September 1, 2017) For the spring term: December 4, 2017 January 31, 2018 (coverage begins February 1, 2018) Once your family members are enrolled in the Student Medical Plan or in both Plans, they are automatically re-enrolled every term as long as you are an eligible student. Each term is billed separately. I ve already waived. Can I re-enroll later? If you change your mind before the waiver deadline, just send an email to stuplan@med.mit.edu saying that you want to withdraw your already-submitted waiver. After the waiver deadline passes, you can only enroll in the Student Extended Insurance Plan if you have a qualifying life event (see definition on page 7). You will have to provide documentation of the event, such as a letter from an insurance company, within 30 days of the event. Otherwise, you are not eligible to re-enroll until the next term. 3
Your medical benefits Your cost for services at MIT Medical (covered under the Student Medical Plan unless otherwise indicated) services outside MIT Medical (covered only if you are also enrolled in the Student Extended Insurance Plan) In-network providers (some services are subject to the annual in-network deductible of $100 per individual; see page 7) Out-of-network providers (most services are subject to the annual out-of-network deductible of $500 per individual; see page 7) Outpatient care Acupuncture (20 visits per calendar year) Allergy serums Not available at MIT Medical No charge if you are also enrolled in the Extended Plan $25 copay (patients will be billed in full and can submit a claim for reimbursement) $25 copay Not covered Allergy testing No charge $25 copay Not covered $25 copay (you will be billed in full and can submit a claim for reimbursement) Chiropractor office visits Not available at MIT Medical $25 copay 20% coinsurance after deductible Diagnostic X-rays, lab tests, and other tests Emergency room visits Family planning services office visits, purchase and insertion of IUD No charge Not available at MIT Medical $50 copay for CT scans, PET scans, MRIs, and nuclear imaging; no charge for other services $100 copay per visit (waived if admitted for inpatient care) No charge Not covered Not covered Flu shots No charge No charge Not covered 20% coinsurance after deductible Deductible waived; $100 copay per visit (waived if admitted for inpatient care) Habilitative services Not available at MIT Medical $25 copay 20% coinsurance after deductible Infertility services Maternity care Office visits (up to 12 visits outside MIT Medical per year. Routine/ preventive services covered at MIT Medical only.) Oxygen and equipment for its administration Pre-matriculation physical examinations & vaccines No charge (services available at MIT Medical are limited) No charge if you are also enrolled in the Extended Plan No charge (no visit limit) $25 copay for office visits; 10% coinsurance on all other services No charge $25 copay, up to the benefit limit; then you pay all costs 20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible, up to the benefit limit; then you pay all costs Not available at MIT Medical No charge 20% coinsurance after deductible Not covered Not covered Not covered Psychopharmacology No charge $25 copay 20% coinsurance after deductible Psychotherapy Routine adult physical exams, including related tests Routine gynecological exams, including related tests (one per calendar year) Routine immunizations No charge Deductible waived; no charge for visits 1 12; $25 copay per visit for all additional visits No charge Not covered Not covered No charge Not covered Not covered No charge (Gardasil, Bexsero, and Trumenba are covered only by the Extended Plan) Not covered Deductible waived; visits 1 12 covered in full up to the allowed amount; 20% coinsurance on all additional visits Not covered 4
Your medical benefits Your cost for services at MIT Medical (covered under the Student Medical Plan unless otherwise indicated) services outside MIT Medical (covered only if you are also enrolled in the Student Extended Insurance Plan) In-network providers (some services are subject to the annual in-network deductible of $100 per individual; see page 7) Out-of-network providers (most services are subject to the annual out-of-network deductible of $500 per individual; see page 7) Outpatient care Routine vision exam (one every 12 months) Short-term rehabilitation therapy occupational, physical, and speech (up to 60 visits per calendar year) Surgery and related anesthesia in an office setting, ambulatory surgical facility, hospital, or surgical day care unit Travel vaccines (yellow fever, typhoid, etc.) No charge if you are also enrolled in the Extended Plan Not available at MIT Medical No charge (services available at MIT Medical are limited) Limited coverage for children through age 5 $25 copay up to the benefit limit; then you pay all costs No charge; $25 copay for office/ ambulatory services Not covered $25 copay per vaccine Not covered Not covered 20% coinsurance after deductible, up to the benefit limit; then you pay all costs 20% coinsurance after deductible Urgent care visits No charge $50 copay 20% coinsurance after deductible Well-child visits No charge Covered through age 5 Not covered Inpatient care General or chronic disease hospital care, including maternity services Mental hospital or substance abuse facility treatment Rehabilitation hospital care (up to 60 days per calendar year) Not available at MIT Medical $100 copay per admission 20% coinsurance after deductible Not available at MIT Medical $100 copay per admission 20% coinsurance after deductible Not available at MIT Medical $100 copay per admission, up to the benefit limit; then you pay all costs 20% coinsurance after deductible, up to the benefit limit; then you pay all costs Other services Ambulance services Durable medical equipment such as wheelchairs, crutches, etc. Pediatric eyewear (covered through age 18) Prescription drugs (up to a 30-day supply for each prescription) No charge for MIT EMS ambulance service when available. No charge (equipment available at MIT Medical is limited) At MIT Optical, if you are also enrolled in the Extended Plan, 50% coinsurance (you will be billed in full and can submit a claim for reimbursement) At the MIT Pharmacy, if you are also enrolled in the Extended Plan, copays as follows: for Tier 1 contraceptives $10 for Tier 1 medications $20 for Tier 2 medications $30 for Tier 3 medications No charge Deductible waived; covered in full 10% coinsurance 20% coinsurance after deductible 50% coinsurance (you will be billed in full and can submit a claim for reimbursement) At a participating Express Scripts pharmacy, copays as follows: for Tier 1 contraceptives $20 for Tier 1 medications $30 for Tier 2 medications $40 for Tier 3 medications Maximum benefit: $20,000 per calendar year 50% coinsurance (you will be billed in full and can submit a claim for reimbursement) Not covered you pay all costs 5
Things to remember Services outside the U.S. If you need health care treatment while traveling outside the United States, the Student Extended Insurance Plan provides the same coverage as within the U.S.; all covered services are considered to be out-of-network. Many facilities require that you pay when you receive care and then file a claim with Blue Cross Blue Shield of Massachusetts. If you need to locate a doctor or hospital, or need medical assistance services, call Blue Cross Blue Shield Global Core at +1-800-810-2583 (or call collect at +1-800-673-1177), 24 hours a day, seven days a week. An assistance coordinator, in conjunction with a medical professional, will arrange a physician appointment or hospitalization, if necessary. See bcbsglobalcore.com for more information. If traveling on an MIT-sponsored trip, you should register with International SOS prior to your departure. See links on vpf.mit.edu/insurance for more information. Your privacy is protected Unless you give us permission, we can t share anything about your visits to MIT Medical with your parents, professors, or friends. Exceptions would be made only in certain lifethreatening situations. For more information on our privacy policy and your rights and responsibilities as a patient, visit medical.mit.edu/privacy. Know your insurance Some services at MIT Medical like routine eye exams, prescriptions, allergy serum, Gardasil, Meningococcal serogroup B vaccines, and obstetrics are not covered under the Student Medical Plan but are covered under the Student Extended Insurance Plan. These services may also be covered under other plans, so even if you waive the Extended Plan, your other insurance may pay for you to receive some of these services at MIT Medical. You will be responsible for any charges that your other insurance does not pay. Make sure you know what medications you re taking and any allergies. Always carry your insurance card, no matter what insurance coverage you have. Useful contact information 24-hour help line 617-253-4481 Urgent Care 617-253-4481 Appointments 617-253-4481 MIT Pharmacy 617-253-1324 Mental Health & Counseling 617-253-2916 For urgent concerns: during the day 617-253-2916 nights/weekends 617-253-4481 Community Wellness 617-253-1316 Limitations and exclusions All benefits are effective September 1, 2017 through August 31, 2018. This is a quick overview. If there is a conflict between this overview and the Blue Cross Preferred Provider Benefit Description, including the addendum (both available at medical.mit.edu/healthplans/student), the Benefit Description and/or addendum govern. The Medical Plan and the Extended Insurance Plan cover only medically necessary services, as defined in the Blue Cross Preferred Provider Benefit Description. Certain services are not covered under either plan, including, but not limited to, custodial care, most educational testing and evaluation, most experimental treatments, hearing aids and hearing aid evaluations, eyeglasses and contact lenses for patients age 19 and older, over-the-counter medicines and products, diet drugs, cosmetic surgery, orthotics, psychoanalysis, dental care, and prescription vitamins. If you have questions, contact Member Services at 617-253-5979 or mservices@med.mit.edu. 6
Commonly used terms Blue Cross Blue Shield ID card A card issued to MIT students by Blue Cross Blue Shield of Massachusetts (BCBS). Health care providers will ask for the information on the card before you receive most services, so it is important to carry the card with you at all times. When you enroll, BCBS will mail your card to the address we have on file for you. Once you have finalized your residence, update your address in both MIT WebSIS and at MIT Medical. If you haven t received your ID card or you need a replacement, call us at 617-253-1616, or email stuplan@med.mit.edu. Coinsurance The portion of eligible expenses you are responsible for paying, most often after the deductible is met. Coinsurance is usually calculated as a percentage of the amount approved by BCBS for the service. If the amount charged by an out-of-network provider is greater than the amount approved by BCBS, you will be responsible for paying coinsurance on the allowed amount, plus 100% of the remaining charges. Copay or Copayment The fixed dollar amount you must pay for a covered health care service, usually when you receive the service. Deductible The total amount you must pay for certain covered services each year before your health plan will begin covering additional costs. The Student Extended Insurance Plan has two distinct deductibles: In-network services: $100 per individual per calendar year. This applies to all outpatient services except mental health care. Out-of-network services: $500 per individual per calendar year. This applies to all services except emergency care. Dependent Your child, up to 26 years old. In-network provider Any healthcare provider (physician, hospital, or other entity) that belongs to the Blue Cross Blue Shield (BCBS) PPO (preferred provider organization). Using an in-network provider will usually cost you less in copays or coinsurance. Out-of-network provider Any healthcare provider that does not belong to the Blue Cross Blue Shield (BCBS) PPO (preferred provider organization). You can use out-of-network providers, but your out-of-pocket expenses will be greater. If an out-of-network provider charges more for a service than BCBS allows for the service, you will be responsible for paying the difference, and that payment is not included in your out-of-pocket maximum. Out-of-pocket maximum An annual limit on the amount of money individuals are required to pay out of pocket for covered healthcare costs, excluding premiums. When the amount you ve paid in a calendar year reaches the out-of-pocket maximum, additional services during the same calendar year will be covered in full. You may still be responsible for the difference between the approved amount and the actual charge for out-of-network services. The Student Extended Insurance Plan has three distinct out-of-pocket maximums: 1. For medical services: $4,000 per individual per calendar year. 2. For prescriptions filled at MIT Pharmacy: $1,000 per individual per calendar year. 3. For prescriptions filled through the Express Scripts pharmacy network, there is a separate out-of-pocket maximum of $1,000 per individual per calendar year. Qualifying life event A change in your circumstances that makes you eligible to change your health insurance enrollments outside of the normal schedule. Examples of qualifying life events include: Turning 26 and becoming ineligible for your parent s plan. The involuntary loss of other health insurance coverage. A dependent s entry into the country. Marriage or qualified same-sex partnership. The birth of a child, legal adoption, or legal guardianship. For more information, see medical.mit.edu/qualifying-events. Waiver A form that officially documents your voluntary cancellation of enrollment in the Student Extended Insurance Plan. Waivers are accepted only when students can show they have other health insurance that meets federal and state requirements. Waivers must be submitted each academic year. Fall term waivers are due by August 31. Spring term waivers are due by January 31. Summer term waivers are due by June 15. 7
Health Plans offices Member Services E23, first floor mservices@med.mit.edu 617-253-5979 Go to Member Services for questions about What your plan covers Insurance ID cards Referrals Claim-reimbursement forms PCP selection or changes Claims Health Plans E23, third floor stuplan@med.mit.edu 617-253-1616 Go to Health Plans for questions about Enrolling in a health plan Adding family members to a health plan or taking them off Health plan costs Waivers Verification of enrollment Billing Office E23, third floor billing@med.mit.edu 617-253-1322 Mailing Address Health Plan E23-308, 77 Massachusetts Ave. Cambridge, MA 02139-4307 Care right here on campus Remember, as an MIT student, you re covered by the Medical Plan even if you waive the Extended Insurance Plan. With the Student Medical Plan, you can use most services at MIT Medical with no out-of-pocket cost. Here are some things you should know: Choose a primary care provider (PCP) Your PCP will coordinate all your care, including necessary referrals to specialists at MIT Medical (usually covered by the Student Medical Plan) or elsewhere (covered by the Student Extended Insurance Plan or your other comprehensive insurance plan, if you have one). Visit medical.mit.edu/choose to see names and photos of PCPs who are accepting new patients, get more information about individual providers, and fill out the online form to make your choice. You can change your selection at anytime. Make an appointment If you need to be seen by a clinician, you can call your primary care provider s office directly. If you re sick and need to be seen the same day, let us know. Urgent Care MIT Medical s Urgent Care Service is open 7 a.m. 11 p.m., seven days a week (check medical.mit.edu for information about holiday and summer hours). To check on wait times or the availability of pediatric clinicians, call ahead: 617-253-4481. Mental Health and Counseling Service On-campus clinicians provide consultation, crisis intervention, and ongoing treatment, including individual and group counseling and psychopharmacology. Services are available to all MIT students with no out-of-pocket cost and no referrals required. Walk-in hours are available on the third floor of MIT Medical Monday through Friday from 2 to 4 p.m. Call 617-253-2916 to make an appointment or to talk to a clinician in urgent situations. Overnight or on weekends, you can reach a mental health clinician by calling MIT Medical s 24-hour number, 617-253-4481. For more information, see medical.mit.edu/mentalhealth. Community Wellness at MIT Medical Explore resources and programs that can help you make healthy choices to get the most out of your time at MIT. Stop by E23, call 617-253-1316, or learn more at medical.mit.edu/wellness. Learn more about MIT Medical at medical.mit.edu 8