2012–2013 Academic Year
Claims and Claim Payments
Blue Cross Blue Shield
BCBS Preferred Providers (Massachusetts and Nationwide)
Blue Cross Blue Shield
Policy Number: 4956160
EyeMed Discount Vision Plan
Basix Dental Savings Plan
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.
Boston 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 credit 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 School of Management Graduate Programs—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
School of Theology and Ministry—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 Insurance Plan Premium Amounts
(Student premiums are charged to student accounts. Premiums for enrolled dependents are paid directly to Gallagher Koster.)
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 14, 2012, for the academic year and by January 25, 2013 for the spring semester only. Students who do not complete a waiver by the deadline will be charged for the student only premium and enrolled in the Student Blue Plan.
Waivers can be submitted electronically on the Agora Portal. International students and students under the age of 18 must complete a written waiver. The form must be signed by the student and a parent or guardian (if under the age of 18). Written waivers are available on the Student Services Forms web page.
Qualifying Student Health Insurance Program (SHIP)
Students are not eligible for any of the subsidized Commonwealth Care programs. They are eligible for the insurance plans offered through Commonwealth Choice but should review these plans carefully, because they may have high deductibles and limited benefits.
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 Student Blue Plan 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.
Boston College is pleased to offer the Blue Cross Blue Shield Student Blue Plan as our student health insurance plan. Students will have access to the BCBS nationwide network of preferred providers and pharmacies and to other BCBS 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 Student Blue Plan 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 GallagherKoster.com/BC and click on "My Benefits and Plan Information" for complete details about coverage, limitations and exclusions.
Prescription Drug Coverage
At designated Express Scripts retail pharmacies, you will pay a $15 co-payment for a 30-day supply of a Tier-1 drug, $30 co-payment for a 30-day supply of a Tier-2 drug, and $50 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 are likewise limited or excluded.
Visit the Blue Cross Pharmacy Coverage webpage to determine which tier applies to your prescriptions, the applicable co-payment, 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 co-payments and help to reduce your overall prescription costs. You will pay a $30 co-payment for a 90-day supply of a Tier-1 drug, a $60 co-payment for a 90-day supply of a Tier-2 drug, and a $100 co-payment for a 90-day supply of a Tier-3 drug.
Coverage for Pre-existing Conditions
Under the Blue Cross Blue Shield Student Blue Plan, a pre-existing condition is covered as any other "Covered Injury or Sickness."
Referrals from University Health Services
A referral is not required with Blue Cross Blue Shield Student Blue Plan, but there are many benefits to first seeking care or advice from Boston College's University Health Services. Visit University 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, 2012, through August 6, 2013. Blue Cross Blue Shield Student Blue Plan provides the same benefits for students while they are on campus or 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 OnCallInternational.com.
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 Student Blue Plan network. Network providers are reimbursed at 100% of the Preferred Allowance. If you seek services from an Out-of-Network provider, you will need to pay for those services and then seek reimbursement. 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.
Blue Cross Blue Shield providers will bill Blue Cross Blue Shield directly. The billing information is on the back of your 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., whether it was the result of a car accident, from playing sports, etc. Your claim cannot be processed without this information, so respond to the letter promptly.
Eye Examinations and Glasses
Blue Cross Blue Shield covers one eye exam every 24 months. In addition, by enrolling in Blue Cross Blue Shield Student Blue Plan, you are also enrolled in the EyeMed Vision Program. EyeMed'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 LensCrafters, 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 Student Blue Plan. However, by enrolling in the Blue Cross Blue Shield Student Blue 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 BasixStudent.com to learn more about the Program, locate participating dental providers, and download the fee schedule.
Refer to the Summary of Benefits (PDF) for a complete list of available benefits as well as the plan's exclusions and limitations.
Coverage after Graduation
Boston College students insured by BlueCross BlueShield can enroll in BlueCross BlueShield's direct non-group plan after their coverage ends through Boston College's program. The number at BlueCross BlueShield is 800-422-3545 to enroll.