MIT Student Health Plan

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1 M A S S A C H U S E T T S I N S T I T U T E O F T E C H N O L O G Y MIT Student Health Plan What you should know about 2 health insurance Rates 2 What MIT Medical offers 3 Your medical benefits 4 How do I enroll or waive coverage? 6 Commonly used terms 7 Things to remember 7 Limitations and exclusions 7 Contact information back cover

2 What you should know about health insurance Most MIT students are required to have health insurance. To help you meet this requirement, MIT Medical offers these health plan options: MIT Student Medical Plan Every student is automatically enrolled in this plan, which covers most services provided at MIT Medical, including primary care, certain medical specialties, urgent care, and mental health care. The cost for your coverage is included in tuition, and you may enroll family members for an added charge (see table below). MIT Student Extended Insurance Plan (SEIP) This plan covers off-campus services such as emergency room visits, hospital stays (including birth of a baby and inpatient mental health/substance abuse care), surgical procedures, and prescriptions. Rates for this plan are listed below. How do I enroll? Why do I need this? MIT Student Medical Plan Enrollment is automatic with registration and paid as part of tuition To have access to services at MIT Medical MIT Student Extended Insurance Plan (SEIP) Enrollment and billing are automatic with registration; to waive, see page 6. Students must enroll unless they have other health insurance coverage that meets Massachusetts state requirements. Remember, all students can receive care at MIT Medical, even if they waive the Student Extended Insurance Plan. MIT Student Medical Plan Full year Sept. 1, 2011 Aug. 31, 2012 Fall term only Sept. 1, 2011 Jan. 31, 2012 Spring term only Feb. 1, 2012 Aug. 31, 2012 No cost No cost No cost Student (automatic enrollment) (included with tuition) (included with tuition) (included with tuition) Student and partner $ 1,152 $ 480 $ 672 Student and dependent(s) $ 588 $ 245 $ 343 Family (student, partner, $ 1,740 $ 725 $ 1,015 and dependents) MIT Student Extended Insurance Plan (SEIP) Student (automatic enrollment) $ 1,848 $ 770 $ 1,078 Student and partner $ 2,820 $ 1,175 $ 1,645 Student and dependent(s) $ 1,992 $ 830 $ 1,162 Family (student, partner, and dependents) $ 2,964 $ 1,235 $ 1,729 Example: Jane is a student who wants to enroll herself and family members in both plans for the full year. She would pay $3,972 to cover herself and her partner, or $2,580 for herself and her dependent(s), or $4,704 for herself, her partner and her dependent(s). 2 MIT Student Health Plan

3 What you can get at MIT Medical Everything under one roof You can get routine and preventive care, pharmacy prescriptions, X-rays, lab tests, and a wide array of medical specialties (with a referral from your primary care provider) all under one roof at MIT Medical. For more information, see our online directory of offices and clinicians at medweb.mit.edu/directory. Primary care providers Students are encouraged to choose a primary care provider (PCP) at MIT Medical. Your PCP will coordinate all your medical care, including making arrangements for specialty consultations at MIT Medical or elsewhere when needed, laboratory tests, and hospitalizations. Visit medweb.mit.edu/directory to learn about our PCPs. To make your choice, use the online PCP choice form available at medweb.mit.edu/choose. Mental health and counseling MIT Medical s Mental Health and Counseling Service provides consultation, crisis intervention, and ongoing treatment, including individual and group counseling and psychopharmacology. The staff has expertise helping people deal with stress, relationship difficulties, academic or job pressure, anxiety, bipolar disorder, psychotic disorders, learning problems and ADHD, eating concerns, insomnia, fatigue, alcohol and substance abuse, family issues and more. Call to make an appointment, or to talk to a clinician in urgent situations or on weekends. Appointments are available Monday through Thursday 8:30 a.m. 7 p.m. and Friday 8:30 a.m. 5 p.m. Walk-in hours for urgent needs are Monday through Friday 2 4 p.m. All calls and visits are strictly confidential. For registered students, all visits at MIT Medical are provided at no additional charge. Urgent care MIT Medical s Urgent Care Service is open seven days a week from 7 a.m. to 11 p.m., and clinicians are available by phone 24 hours a day, even when Urgent Care is closed. Examples of conditions that require urgent care include high fever, earaches and sprains. If the situation seems urgent but not lifethreatening, call us at (24 hours a day) to find out what to do next. Based on your symptoms, we ll answer your questions and give you advice. You can be seen in Urgent Care whenever it s open, even if you don t call first, but you may have to wait. Like an emergency room, the most urgent medical cases are seen first. Community Care Center Nurse care managers in the Community Care Center (CCC) coordinate medical services and resources at MIT Medical and other locations. They can help arrange outpatient rehabilitation services and transportation to medical appointments, and they can make house calls to sick students in their dorm rooms when appropriate. The CCC also provides on-site care including infusions, observation, and post-procedure and wound care. Making an appointment at MIT Medical Call your primary care provider s office directly (see the MIT Medical website at medweb.mit. edu for phone numbers), or call the triage nurse at When making an appointment, it s helpful to briefly describe the reason for the visit, so we can schedule an appointment of the correct length and make sure the appropriate resources are available. If you re sick and need to be seen the same day, let us know. Online access Patient Online provides MIT Medical patients with a private and secure way to review certain parts of their health history online and non-urgent questions to participating clinicians. All you need to do is register for an account. To learn more, visit medweb.mit.edu/ about/patientonline or log on at pol.mit.edu. Life-threatening emergencies Off-campus emergencies: Call 911 On-campus emergencies: Call Campus Police at x100 or MIT Student Health Plan 3

4 Your medical benefits Covered services Outpatient care Your cost at MIT Medical (services are covered under the MIT Student Medical Plan unless otherwise indicated) Your cost for services outside MIT Medical (covered only if you are also enrolled in the MIT SEIP) Your cost for benefits using the Blue Cross PPO network Your cost for out-ofnetwork benefits (after your deductible) Emergency room visits Not available at $50 copay per visit Deductible waived; $50 MIT Medical (waived if admitted) copay per visit (waived if admitted) Well-child visits Covered in full Limited coverage for Not covered children under age 5 Routine adult physical exams, including Covered in full Not covered Not covered related tests (pre-matriculation exams and shots are not covered) Allergy testing and serums Covered in full (serums Not covered Not covered covered only if you are also enrolled in SEIP) Routine immunizations, including Covered in full (Gardasil is Not covered Not covered flu shots covered only if you are also enrolled in SEIP) Travel vaccines $25 copay Not covered Not covered Routine gynecological exams, including Covered in full Not covered Not covered related lab tests (one per calendar year) Maternity care Covered in full, if you are also Covered in full 20% coinsurance enrolled in SEIP Family planning services office visits Covered in full Not covered Not covered Family planning services purchase $45 copay (covered only if Not covered Not covered and insertion of IUD you are also enrolled in SEIP) Infertility services No charge (though only $20 copay, up to the benefit 20% coinsurance, up to (maximum $5,000 benefit limit per limited services available) limit; then you pay all costs the benefit limit; then you member per calendar year) pay all costs Office visits (up to 12 visits outside Covered in full (visit limit does $20 copay per office visit; 20% coinsurance, up to MIT Medical per year) not apply) other services covered in full, the benefit limit; then you up to the benefit limit pay all costs Chiropractor office visits (maximum Not available at $20 copay per visit, up to 20% coinsurance, up to benefit of $1,500/year per member) MIT Medical the benefit limit; then the benefit limit; then you you pay all costs pay all costs Routine vision exam Covered in full, if you are also Limited coverage for Not covered (one every 12 months) enrolled in the MIT SEIP children under age 5 Short-term rehabilitation therapy Not available at $20 copay per visit, up to 20% coinsurance, up to physical, occupational and speech MIT Medical the benefit limit; then the benefit limit; then you (up to 36 visits per calendar year) you pay all costs pay all costs Mental health and substance abuse Covered in full Visits 1-12 covered in full, Deductible waived. Visits treatment (limited to one visit per week $20 per visit for visits 13-24, 1-12 covered in full, 20% and combined maximum of 24 visits then you pay all costs coinsurance on visits 13-24, per calendar year) then you pay all costs Psychopharmacology Covered in full $20 copay, up to the benefit Deductible waived. 20% co- (up to 8 visits per year) limit; then you pay all costs insurance, up to the benefit limit; then you pay all costs Oxygen and equipment for Not available at Covered in full 20% coinsurance its administration MIT Medical 4 MIT Student Health Plan

5 Covered services Your cost at MIT Medical (services are covered under the MIT Student Medical Plan unless otherwise indicated) Your cost for services outside MIT Medical (covered only if you are also enrolled in the MIT SEIP) Your cost for benefits using the Blue Cross PPO network Your cost for out-ofnetwork benefits (after your deductible) Outpatient care (continued) Diagnostic X-rays, lab tests, and Covered in full $50 copay on CT scans, 20% coinsurance other tests MRIs, PET scans and nuclear imaging; other services covered in full Surgery and related anesthesia Covered in full, but limited Covered in full 20% coinsurance office setting, ambulatory surgical services available at MIT facility, hospital or surgical day care unit Medical Inpatient care (including maternity care) General or chronic disease hospital care Not available at $100 copay per admission 20% coinsurance, up to the (combined maximum of 120 days per MIT Medical benefit limit; then you pay calendar year) all costs Mental hospital or substance abuse Not available at $100 copay per admission 20% coinsurance, up to the facility care (combined maximum of 120 MIT Medical benefit limit; then you pay days per calendar year; all admissions all costs must be authorized in advance by MIT Mental Health and Counseling, except emergency admissions) Rehabilitation hospital care Not available at $100 copay per admission 20% coinsurance, up to the (combined maximum of 120 days per MIT Medical benefit limit; then you pay calendar year) all costs Other services Ambulance services (up to a maximum Not available at No charge (up to the benefit Deductible waived; no charge of $10,000 per illness for air ambulance) MIT Medical limit) (up to the benefit limit) Prescription drugs (up to a 30-day At the MIT Pharmacy only if At a participating Express Not covered supply for each prescription) you are also covered under Scripts pharmacy: the MIT SEIP: $15 for Tier 1 medications $5 for Tier 1 medications $25 for Tier 2 medications $15 for Tier 2 medications $35 for Tier 3 medications $25 for Tier 3 medications Maximum benefit: $10,000 Maximum benefit: $100,000 per calendar year per calendar year Durable medical equipment including Not available at Covered in full, up to the 20% coinsurance, up to the wheelchairs, hospital beds, crutches, etc. MIT Medical benefit limit; then you pay benefit limit; then you pay (up to $5,000 per calendar year) all costs all costs Out-of-country coverage Services outside the United States Not covered Same coverage as within U.S.; all covered services are considered to be out-of-network. Many facilities require that you pay at time of care and then file a claim with Blue Cross Blue Shield of Massachusetts. You must contact BCBS worldwide network ( , or for collect calls) for inpatient admissions. See bluecard-worldwide.html. If traveling on an MIT-sponsored trip, you should register with International SOS prior to your departure. See link on vpf.mit.edu/insurance for more information. MIT Student Health Plan 5

6 How do I enroll or waive coverage? Students All MIT students registered for at least 12 units per term are automatically enrolled in the Student Medical Plan at no additional charge (the cost is included with tuition). Students registered for 27 units or more per term are also automatically enrolled in the Student Extended Insurance Plan (SEIP), and charges for SEIP will appear on their student bills. If you plan to waive coverage under SEIP, read the FAQs and complete the online waiver form at medweb.mit.edu/waive. All students who ask to waive the SEIP are required to provide proof of comparable insurance coverage. You will be responsible for paying the insurance charge on your student bill if you do not waive by the deadline. Others are eligible to enroll in SEIP, though enrollment is not automatic. You must come to the Health Plans office in Room E to enroll in SEIP if you are: A student who wants to enroll family members A visiting student A student taking fewer than 12 units per term You must enroll or waive before the term s open enrollment deadline (September 15 for the fall term, February 15 for the spring term, and June 15 for the summer term) or within 31 days of arrival in the United States. Family members of students Students may enroll partners (spouses or spousal equivalents) and dependents (unmarried children up to 26 years old) in the Student Medical Plan or the Student Extended Insurance Plan. You must provide proof of your partner s or family members eligibility when you add them to your benefits coverage. Proof of eligibility includes: A marriage certificate for you and your partner A Domestic Partner/Spousal Equivalent Affidavit of Domestic Partnership form for you and your spousal equivalent, and proof that you are living together A birth certificate for your dependent child that shows the name of the child and the name of the parent, or a passport if it shows the parent/ child relationship Family members who enroll in the Student Extended Insurance Plan must re-enroll each fall, and they will be billed for each academic term. Students and affiliates can enroll family members at the same time they enroll, or at the beginning of an academic semester (September 1 or February 1). If you arrive at MIT from another country before your family members, you must enroll them within 31 days of their arrival in the United States. You will need to provide proof of their arrival, such as a stamped passport, visa or airline ticket. 6 MIT Student Health Plan

7 Commonly used terms Blue Cross Blue Shield ID card A card issued to members of the MIT Student Extended Insurance Plan by Blue Cross Blue Shield of Massachusetts. ID cards are mailed to the address on file at MIT Medical in September, after the waiver period has ended. If you haven t received your ID card and you need your insurance number, visit the MIT Health Plans Office in Room E or call Co-insurance The portion of eligible expenses that you are responsible for paying, most often after the deductible is met. Co-insurance is usually determined as a percentage of the total provider s actual charge, or the allowed amount. Copayment The specified dollar amount you pay when receiving certain treatments, services, or supplies. Also called a copay. Deductible The dollar amount you must pay for covered out-of-network health care services before your health plan will cover additional services that year. The deductible for the MIT Student Medical Plan is $250 per individual per calendar year. Dependent An unnmarried child up to 26 years old. In-network provider Any health care provider (physician, hospital, etc.) that belongs to a health plan s network. Using an in-network provider will usually cost you less in copayments or co-insurance. Out-of-network provider Any health care provider that does not belong to a Blue Cross Blue Shield PPO provider network. You can use your benefits for out-of-network expenses, but your out-of-pocket expenses will be greater. Out-of-network providers can bill you the difference between the allowed charge and their actual charge, and this amount is not included in your out-of-pocket maximum. Out-of-pocket maximum The maximum dollar amount (deductible plus co-insurance) you will pay in a calendar year for certain covered services. When the amounts you ve paid in a calendar year add up to the out-of-pocket maximum, full benefits will be provided based on the allowed charge if the member continues to receive those covered services during the rest of the calendar year. However, you ll still be responsible for any applicable copayments. The out-of-pocket maximum under the MIT Student Medical Plan is $2,000 per individual or $4,000 per family per calendar year. Waiver A form that officially documents voluntary cancellation of membership in the MIT Student Extended Insurance Plan. Student waivers are accepted only when students can show they have other health insurance that meets Massachusetts requirements, and waivers must be submitted each academic year. Things to remember Know your insurance. Some services at MIT Medical like eye exams, physical therapy, prescriptions, and obstetrics are not covered under the MIT Student Medical Plan, but are covered under the MIT Student Extended Insurance Plan. (If you waive extended coverage, your other insurance may pay for some of these services at MIT Medical.) Know yourself. Make sure you know what medications you re taking and any medical allergies. Always carry your insurance card, no matter what insurance coverage you have. Your privacy is protected. Unless you give your permission, nothing about your visits to MIT Medical will be shared with your parents, professors or friends. The only exception would be in a life-threatening situation. Limitations and exclusions Both plans cover medically necessary services only. Certain services are not covered under either plan, including custodial care, most educational testing and evaluation, most neuropsychological and psychological testing, most experimental treatment, hearing aids and hearing aid evaluations, eyeglasses, contact lenses, over-the-counter medicines and products, diet drugs, cosmetic surgery, orthotics, psychoanalysis, and prescription vitamins. All benefits are effective September 1, This is a quick overview. If there s a conflict between this overview and the Benefit Description, including the addendum (available at medweb.mit.edu/healthplans/student), the Benefit Description and/or addendum govern. If you have questions, please contact Claims and Member Services at or MIT Student Health Plan 7

8 Contact information 24-hour urgent care Appointments and general information Pediatrics Mental Health and Counseling (Monday-Friday, 8:30 a.m. 5 p.m.; at other times, call ) Obstetrics and Gynecology MIT Pharmacy Patient Online pol.mit.edu Community Wellness at MIT Medical Directory of all MIT Medical services and providers medweb.mit.edu/directory Health Plans Office (eligibility and enrollment questions) Claims and Member Services (coverage and claim questions) Blue Cross Blue Shield of Massachusetts Customer service Locate a provider MIT Medical Building E23 25 Carleton St. Cambridge, MA medweb.mit.edu

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