Clark University
STUDENT HEALTH INSURANCE PLAN

GENERAL

Who is Blue Cross Blue Shield of MA? Who is University Health Plans? What are their roles?

Blue Cross Blue Shield (BCBS) of MA is the claims administrator and insurance company for the Student Health Insurance Plan. BCBS is responsible for answering questions about insurance benefits, processing claims, and providing replacement ID cards. If you have any questions for BCBS, please call 888-753-6615.

University Health Plans (UHP) is the broker/plan manager and handles the enrollment and waiver process for the BCBS Student Health Insurance Plan. Please call UHP at 800-437-6448 if you have any questions about the enrollment and waiver process or if there are customer service issues with BCBS.

What is a PPO?

A PPO is a Preferred Provider Organization. It is a type of Preferred Provider Option health insurance plan that allows you to see any doctor or specialist of your choice. It does not require that you have a primary care physician. The Clark University Student Blue Plan is a PPO plan.

Who should I contact for updating my personal information such as a mailing address, name, etc.?

Please update your personal information at your school first, then call UHP at 800-437-6448 to update your personal information so that your record can be updated with BCBS.

I'm enrolled in the Clark University Student Health Plan for the fall, but am switching to part-time in the spring or am not taking classes in the spring. Can I cancel my Student Health Plan early?

If you will not be attending Clark University courses in the spring semester, you may request that your plan is changed to Fall Only. If you have obtained a MassHealth or state-subsidized Connector Plan that is effective on/before January 1st, you may request that your plan is changed to Fall Only by supplying the Student Accounts Office with proof of your new plan’s effective date. In either case, the request must be made by January 31st of that policy year.

I'm enrolled in the Clark University Student Health Plan and now have other insurance coverage. Can I cancel my Student Health Plan early?

If you will be graduating at the end of the fall semester, you are eligible to request a Fall Only plan (December 31st termination date) if you make your request with Student Accounts by February 15th. All other students will remain enrolled in the Student Health Plan through the end of the policy year (August 14th) and will be responsible for paying the corresponding premium.

 


WAIVER

What are the requirements for waiving the Clark University Student Health Plan?

To waive to Clark University Student Health Plan, your insurance plan must meet the following criteria:

  • The plan must provide to the student reasonably comprehensive coverage of health services, including preventive and primary care, emergency services, hospitalization benefits, ambulatory patient services and mental health services throughout the school year.
     
  • The full range of services covered under the health plan must be reasonably accessible to the student in the Worcester, MA area."
     
  • The plan must be provided by a U.S.-based insurance carrier.
     
  • The plan must not be a Health Safety Net Plan, MassHealth Limited Plan, or Children’s Medical Security Program. MassHealth plans other than MassHealth Limited are acceptable.
     
  • The plan must not be an out-of-state HMO (such as Kaiser) that only provides access to emergency care in the area surrounding the University.

I'm an international student and cannot access the Waiver Form on this site. How can I request to waive this plan?

International students can find additional information about waiving by going to:
http://www.clarku.edu/offices/business/businessmanager/docs/insurance_international_students.pdf

I completed a waiver for this year already but now my other insurance coverage is ending. What should I do?

If your other insurance has terminated or will be terminating, you may be eligible to enroll mid-year due to a qualifying event. For more information, contact the Student Accounts Office at Clark University as soon as possible. If you are eligible to enroll due to a qualifying event, you will be given no more than 60 days from the termination date of your prior coverage to formally request enrollment in the Clark University Student Health Plan. As part of your formal enrollment request, you will be required to provide written proof (a letter or certificate) from your insurance company indicating your plan's termination date. This document may take some time for you to obtain.

 


ENROLLMENT

Can I enroll in the insurance plan after the enrollment deadline?

You can enroll in the BCBS plan after the enrollment deadline should a qualifying event (loss of other coverage) occur while school is in session. Examples of qualifying events include reaching the dependent are age limit under a parent's policy, marriage, etc. You must supply written proof that your other coverage has terminated through a qualifying event. Once you have terminated coverage from your current insurance carrier, you have 60 days after your termination to enroll in the BCBS Student Health Insurance Plan. To be eligible to enroll, you must also be attending classes for the 60 days following the termination of your other plan.

I have purchased coverage for myself, but can I also purchase coverage for my dependents (spouse, child)?

No. Clark University's Student Blue Plan is only available to registered students who are enrolled in classes at least ¾ full-time. If you live in Massachusetts, please visit www.mahealthconnector.org to view possible insurance options for your dependents. If you live outside of Massachusetts, you may visit www.healthcare.gov.

 


ID CARDS

Do I get an insurance card?

Yes. Once you are enrolled in the BCBS Student Health Insurance Plan, an insurance card will be sent to you. In the event that the card does not arrive on time, you can still receive medical services as long as you are enrolled in the BCBS eligibility system.

What if I lost my insurance card?

Please contact BCBS at 888-753-6615 to obtain another insurance card.

 


PROVIDERS

What does in-network and out-of-network mean?

An in-network provider is one contracted with BCBS preferred Provider Option plan to provide services to plan members for specific pre-negotiated rates. An out-of-network provider is one not contracted with BCBS or the BCBS Preferred Provider Option plan. Typically, if you visit a physician or other provider within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network provider. For example, BCBS might pay 100% of the contract rate minus your co-payment for an in-network doctor’s office visit compared to only 80% for an out-of-network provider.

Which network of doctors and hospitals do I have access to?

The Clark University Student Blue Plan utilizes the Blue Care Elect Preferred PPO Network.

Where can I get a directory or list of participating providers?

You have access to the BCBS provider network. To find a list of participating providers in the BCBS network, please visit http://bcbs.prismisp.com/.

What if I go to a provider who does not participate in my BCBS PPO network?

If you see a provider who is not part of the BCBS PPO network, you will have to pay more out of your own pocket and will be responsible for any applicable co-insurance and any amount above the usual and customary fee for providers. It is to your advantage to see a preferred care provider to maximize your benefits. However, if you decide to seek treatment out of network and are charged by the provider at the time of your service, you may submit a claim form and itemized bill to BCBS to request reimbursement for eligible charges.

When scheduling an appointment, should I tell the provider's office that I have BCBS?

Yes. If you are scheduling an appointment with a provider, you should inform the office of the plan type that is on the top of your insurance card. The Clark University Student Blue Plan is a BCBS Blue Care Elect Preferred PPO plan.

 


CLAIMS

Is it my responsibility to file a medical claim?

If you visit an In-Network BCBS Preferred Provider, the provider MUST file a medical claim on your behalf. In the event that the provider is out- of-network and does not submit a claim for you; you will need a claim form to submit for payment, which can be found at www.bcbsma.com.

If I am in a car accident or I have an injury, what documents will I need in order to submit a claim form for reimbursement?

You will be asked for a description of the accident, information on any other insurance coverage which you hold, and perhaps a police report. A letter from BCBS will be sent to you requesting the pertinent information.

What are some of the reasons BCBS might not reimburse my medical provider for a claim I submitted?

Other insurance may be responsible for paying the claim; the services may not be covered according to the exclusions listed in your Plan Document available online at www.universityheathplans.com; the claim may not have occurred while you were covered; or the charges may be greater than what is Reasonable and Customary. A letter or explanation of benefits from BCBS will accompany any denial of claim.

How can I check the status of a claim I submitted?

You can check the status of a claim that you or the provider has submitted by registering on the Member Central tool on the BCBSMA website or by contacting BCBS at 888-753-6615.

When do I have to fill out a claim form?

The only time that you would need to fill out a claim form is if your pharmacy or provider does not participate with BCBS and bills you directly and you pay out of pocket at the time of service.

Where can I find a medical claim form and a prescription claim form?

You can obtain a copy of the medical claim form or Rx claim form by visiting www.bluecrossma.com.

 


BENEFITS

If I have a benefit question about my policy, who should I ask?

Please refer to all benefits in your student health insurance plan document. If you still need assistance, please contact BCBS at 888-753-6615 and a customer service representative will be able to assist you with your benefit questions.

Does the student insurance plan cover prescription drugs?

Yes, your plan does include prescription drug coverage. Please refer to the brochure and subscriber certificate (both available at www.universityhealthplans.com) for details.

Which pharmacy can I use to fill my prescription?

You can go to any pharmacy that is part of the BCBS Management network. If you need to get a provider listing or inquire about a participating pharmacy, please contact BCBS at 888-753-6615.

What do I do if I am sick and need to go to the hospital?

Your Student Health Insurance Plan may require you to contact BCBS when you are being admitted to the hospital on an inpatient basis. Outpatient services, including day surgery and emergency room visits, may not need to be pre-certified. Please check your plan document by visiting www.universityhealthplans.com.

Am I covered for medical treatment while studying or traveling abroad?

Yes. No matter where you travel as a student, you are covered under the student health insurance medical plan worldwide 24 hours a day. If you are enrolled in the student health insurance medical plan, you may be eligible for additional traveling services through AIG. You may be covered for accidental death and dismemberment, evacuation, and repatriation coverage. Please contact UHP at 800-437-6448 for additional info on coverage limits.

Does my health insurance plan cover treatment for substance abuse and mental illness?

The BCBS Student Health Insurance Plan provides coverage for medically necessary treatment of substance abuse and mental illness conditions. Generally, the extent of coverage depends on whether the treatment is provided on an inpatient or outpatient basis. Please refer to you student health insurance plan document for specific details or call the BCBS toll-free at 888-753-6615.

Does my health insurance plan cover pregnancy?

The BCBS Student Health Insurance Plan provides coverage for a pregnancy on the same basis as any other medical condition. Please refer to your BCBS student health insurance plan document for specific details or call BCBS at 888-753-6615.

 


VISION & DENTAL

Does the medical plan offer any vision benefits?

Yes, the BCBS Student Health Insurance Plan offers one routine vision exam every 24 months. If you are under the age of 19, you are covered for an exam every 12 months. In addition, UHP offers a voluntary VSP vision care plan. Please visit www.universityhealthplans.com, click on alternative insurance products, and select VSP vision to learn more about the benefits and the enrollment process.

Does the medical offer any dental benefits?

The BCBS Student Health Insurance Plan covers members for certain dental services until they reach the age of 19. Members 19 and over are not covered for any dental services under the medical plan.

Does UHP provide a voluntary dental plan for MA students?

Yes, a voluntary dental plan is available for MA students and their dependents. If interested, please visit UHP's website, www.universityhealthplans.com, to learn more about the plan's benefits and to find the enrollment form.