CONTACTS AND QUESTIONS
Enrollment, Benefits, Replacement IDs
Gallagher Koster
500 Victory Road
Quincy, MA 02171
800-394-4026
BCstudentinsurance@kosterins.com
Claims and Claim Payments
Blue Cross Blue Shield
http://www.bluecrossma.com/
Blue Cross Blue Shield Preferred Providers (Massachusetts and Nationwide)
Blue Care Blue Shield
Policy Number: 4956160
http://www.bcbs.com/healthtravel/finder.com/
Participating Pharmacies
ExpressScripts
http://www.express-scripts.com/
EyeMed Discount Vision Plan
866-839-3633
http://www.enrollwitheyemed.com/
Basix Dental Savings Plan
888-274-9961
http://www.basixstudent.com/
All students enrolled in a degree program, regardless of credit hours, and non-degree students enrolled at least 75% of full-time will be automatically enrolled in and billed for the Student Health Insurance Plan.
Boson College will also automatically enroll and charge non-degree graduate and WCAS students registering at the credit levels listed below for the Student Health Insurance Plan. Failure to maintain these credits levels will result in the termination of the mandatory health insurance plan. Students are responsible for monitoring their eligibility status.
Eligible credit levels:
Graduate School of Arts and Sciences—7 or more
Lynch School of Education, Graduate—7 or more
Carroll Graduate School of Management—7 or more
Connell Graduate School of Nursing —7 or more
Graduate School of Social Work—7 or more
Woods College of Advancing Studies, Undergraduate—9 or more
Woods College of Advancing Studies, Graduate—7 or more
Post doctorate students are eligible to enroll on a voluntary basis.
Students who are not citizens or permanent residents of the United States will
be automatically enrolled in the Boston College plan regardless of the number
of their credit hours.
Student Waiver Process
Students who do not want to be enrolled in the Student Health Insurance Plan
can waive it by providing proof of comparable coverage. All waiver forms must be submitted by September
12, 2008 for the first semester and for newly enrolled students for the second
semester by January 27, 2009. Students who do not complete a waiver form by
the deadline will be billed the Student Only premium and enrolled in the Plan. If you waive the insurance at the beginning of the first semester it will be
waived for the entire year.
Students over the age of 18 must complete the electronic waiver by logging
onto
http://agora.bc.edu/.
Students under the age of 18 must complete a written waiver. The form must be signed by the student and the parent or guardian. Written waivers are available on the Student Services forms page.
Qualifying Student Health Insurance Program (QSHIP)
Students are not eligible for any of the subsidized Commonwealth Care programs.
They are eligible for the insurance plans offered through Commonwealth Choice.
However, you should review these plans carefully because they have very high
deductibles and sometimes limited benefits.
ID Cards
You will receive an insurance ID card at either the on-campus or local address
that BC has on file for you. Carry your insurance ID card at all times Show
it to any health care provider or pharmacy before receiving care or filling
a prescription.
If you need to see a doctor before you receive your ID, tell the provider that you are covered by the Blue Cross Blue Shield Blue Care Elect Preferred PPO offered through Boston College. You do not need your card in order to be eligible to receive benefits. Your provider can call Gallagher Koster at 800-394-4026 to verify eligibility.
INSURANCE PLAN BENEFITSBoston College is pleased to offer the Blue Cross Blue Shield Blue Care Elect Preferred PPO as their student health insurance plan. Students will have access to the BCBS nationwide network of preferred providers and pharmacies and to other BCBNS programs, such as fitness benefits reimbursement for designated weight loss programs, or “Living Healthy Naturally” – discounts on different types of complementary and alternative medicine services.
Blue Cross Blue Shield Blue Care Elect Preferred (PPO) Coverage
The plan offers comprehensive benefits that include hospital room and board,
inpatient and outpatient surgical procedures, lab work, x-rays, chemotherapy,
radiation, inpatient and outpatient mental health, physician office and consultant
visits, ambulance, and prescription drugs.
Refer to the plan’s brochure, available at http://www.gallagherkoster.com/. Select
Boston College from the drop down menu. Click on “Plan Documents”
for complete details about coverage, limitations, and exclusions. You can also
review the plan on the Student Services Medical Insurance page.
Prescription Drug Coverage
At designated Express Scripts retail pharmacies, you will pay a $10 co-payment
for a 30-day supply of a Tier-I drug, $25 co-payment for a 30-day supply of
a Tier-2 drug, and $45 co-payment for a 30-day supply of a Tier-3 drug.
Outpatient medications for treatment of a covered expense are covered prescriptions. If the treatment of a medical condition is limited or excluded, the outpatient prescriptions is likewise limited or excluded.
Visit the BlueCross Pharmacy Coverage page to determine which
tier applies to your prescriptions, the applicable copayment, and for any substitutions.
Mail Service Prescription Drug Program
Medications that are taken for a chronic condition can be filled for up to a
90-day supply using Express Scripts’ Mail Service Prescription Drug Program.
Using the mail service will reduce your out-of-pocket copayments and help to
reduce your overall prescription costs. You will pay a $20 co-payment for a
90-day supply of a Tier-1 drug, a $50 co-payment for a 90-day supply of a Tier-2
drug, and a $90 co-payment for a 90-day supply of a Tier-3 drug.
Coverage for Pre-existing Conditions
Under the Blue Cross Blue Shield Blue Care Elect Preferred PPO a pre-existing
condition is covered as any other “Covered Injury or Sickness.”
Referrals from Health Services
A referral is not required with Blue Cross Blue Shield Care Elect Preferred
PPO, but there are many benefits to first seeking care or advice from Health
Services. Visit the Health Services website for more information.
Coverage Off-Campus
If you paid the premium for the entire year, you will be covered from August
7, 2008 through August 6, 2009. Blue Cross Blue Shield Blue Care Elect Preferred
PPO provides the same benefits for students while they are on-campus, on semester
breaks, summer vacation, or study or travel abroad.
You can go online to
BlueCross BlueShield Association
to help find overseas providers.
In addition, you will also be covered for Repatriation of Remains, Emergency Medical Expense Benefit and Travel Assistance Services through On Call International, the 24-hour worldwide assistance service.
While studying or traveling abroad, keep your identification card with you and take a copy of the brochure for reference. When outside the United States, you will likely be asked to pay for your medical care first and then will need to seek reimbursement. Covered Expenses will be reimbursed on a Non-Network basis. When you submit claims for reimbursement, you will need to have the itemized bill(s) translated into English and include a letter informing the claims administrator that you are seeking reimbursement for charges previously paid. Be sure to include your name, ID number, address (to receive your reimbursement check), and the University’s name on the bill.
On Call International can be reached toll free from the United States or Canada
at 800-850-4556 or visit
http://www.oncallinternational.com/.
Deductibles
Once you have paid the $200 deductible, whether it is applied to one or multiple
services, the plan will pay for covered medical expenses as indicated in the
brochure. The deductible applies per person per policy year for services received
from an In-Network provider. Blue Cross Blue Shield Elect Preferred PPO has
a $200 per person deductible for Non-Network providers.
Providers
You can go to any provider; however, you can save money out-of-pocket by seeing
those who participate in the Blue Cross Blue Shield Blue Preferred Provider
PPO network. Network providers are reimbursed at 100% of the Preferred Allowance.
Out-of-Network providers are reimbursed at 80% of Usual and Customary charges
after you have met your deductible.
Preferred Allowance is a preferred negotiated fee that providers have agreed to accept as their payment. Out-of-Network providers have not agreed to accept the Preferred Allowance as their payment.
You should be aware that Network hospitals might be staffed with Out-of-Network doctors, so there is no guarantee that all charges will be paid at the preferred allowance.
Take the time to ask the providers you want to see if they participate in one of the Blue Cross Blue Shield preferred provider organization (PPO) networks.
Even when traveling outside of Massachusetts you will have access to any Blue Cross Blue Shield preferred provider anywhere in the United States.
BCBS Participating Providers
Visit the
BlueCard Provider Finder website to find providers in Massachusetts,
or anywhere in the country or call Member Services at 800-241-0803.
Claims Processing
Blue Cross Blue Shield providers will bill Blue Cross Blue Shield directly.
The billing information is on the back of your of health insurance ID card.
If you receive a bill, call the Member Services’ toll free number on the
front of your ID card for instructions on how to submit your claim.
If the treatment you received was a result of an accident, you will receive a letter from Blue Cross Blue Shield asking you for information about the accident, e.g., was it the result of a car accident, from playing sports, etc. Your claim cannot be processed without this information, so respond to the letter promptly.
PLAN ENHANCEMENTSBlue Cross Blue Shield covers one eye exam every 24 months. In addition, by enrolling in Blue Cross Blue Shield Blue Care Elect PPO plan, you are also enrolled in the EyeMed Vision Program. Eye Med’s plan includes discounts on prescription eyeglasses, contact lenses, and non-prescription sunglasses. Some of the nation’s most highly qualified laser vision correction surgeons will even offer savings. This is not an insurance plan.
EyeMed has over 45,000 providers, including Lens Crafters, Pearle Vision, Sears
Optical, JC Penney Optical, and Target Optical. Visit the
EyeMed website.
Dental Savings Plan
There is no dental coverage through Blue Cross Blue Shield Blue Care Elect Preferred
PPO. However, by enrolling in the Blue Cross Blue Shield Blue Care Elect Preferred
PPO plan, you are also enrolled in the Dental Savings Plan. The Dental Savings
Plan includes an exclusive plan operated by Basix, LLC, which provides students
with access to general and specialty dental care from a select network of local
dentists who have met strict credentialing and quality assurance requirements.
The participating dental providers have agreed to accept negotiated prices for
the services they provide.
Students will be responsible for paying for services they receive at the time of the visit. You will generally save from 20% to 50% of charges for a wide range of dental services—from routine cleanings to root canals. Because the Dental Savings Program is not an insurance plan, there are no claim forms, annual maximums, benefit limitations and conditions, or other plan provisions.
Visit
http://www.basixstudent.com/
to locate participating dental providers, download the fee schedule, and to
learn more about the Program.
Continuing Coverage
There is a Continuation Plan through Blue Cross Blue Shield. You can contact
Gallagher Koster for other options.
Refer to the Summary Plan for a complete list of available benefits as well as the plan’s exclusions and limitations.