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 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. Please refer to your plan document at www.universityhealthplans.com to see if your plan is a PPO plan.
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.
How do I search for providers that are in 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 with BCBS?
If you see provider who is not part of the BCBS 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.
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, please contact firstname.lastname@example.org.
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 and you are actively attending classes. 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.
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.
I have purchased coverage for myself, but can I also purchase coverage for my dependents (spouse, child)?
Please refer to your BCBS student health insurance plan document at www.universityhealthplans.com or call UHP at 800-437-6448 to see if your plan provides dependent coverage.
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.
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.
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. To learn more about the worldwide program and access BCBS's worldwide network of providers please visit www.BCBS.com/bluecardworldwide or call the BlueCard Worldwide Service Center at 800-810-2583 or call collect at 804-673-1177. In-network hospitals will directly bill BCBS for services. Office visits, prescriptions, or other outpatient services will have to be paid for up-front and then the member can submit a claim form to BCBS for reimbursement. Please visit www.BCBS.com/bluecardworldwide to download an international claim form.
If you are enrolled in the student health insurance medical plan, you may be eligible for additional traveling services through Chartis. 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.
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.
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, and then call UHP at 800-437-6448 to update your personal information so that your record can be updated with BCBS.
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.
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.bcbsma.com.
What happens if I drop out of school while I am enrolled in your insurance plan? Will you refund my money? Will I still be covered?
Insured students who withdraw from school after the 31st day following the first date of eligibility of the policy period will remain enrolled in the qualified Student Health Insurance Plan for the full period for which the premium was paid. There will be no refund of premium.
Does the student insurance plan cover prescription drugs?
Please refer to your health insurance plan document at www.universityhealthplans.com to check to see if your plan provides prescription coverage.
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.
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.
Does this plan offer any vision benefits?
Yes, the BCBS Student Health Insurance Plan offers one routine vision exam every 24 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.