Student Health Insurance
Frequently Asked Questions
For Merrimack College Students
2013-2014 Student Blue Plan
All full-time and three quarter time students, as defined by the school, will be automatically enrolled in and billed for the Merrimack College Student Blue Plan.
How can I remove the health insurance charge?
The Commonwealth of Massachusetts mandates that all students enrolling in nine (9) or more credit hours must be covered by health insurance. If you have other coverage you must complete the waiver form online by September 9, 2013. If you do not complete the waiver form online, you must be billed for health insurance. If the waiver is completed after the due date, we will not be able to reverse the billing for the health insurance.
Important Contact Information
I have questions about what is covered, how to access benefits, enrollment concerns, or replacement ID cards.
500 Victory Road
Quincy, MA 02171
Phone: 1-800-401-6074 or 1-617-769-6035
I have questions about a specific claim or claims payment.
BlueCross BlueShield of Massachusetts
How can I find a Preferred Provider?
BlueCard Provider Finder
Phone: 1-800-810-BLUE (2583)
How can I find a Participating Pharmacy?
How do I learn more about Gallagher Koster Complements?
EyeMed Discount Vision Plan
Basix Dental Savings and CampusFit
How do I learn more about Worldwide Assistance Services?
On Call International
Collect from anywhere in the world: 1-603-898-9159
Toll free from the US or Canada: 1-800-407-7307
How do I reach the 24/7 Blue Care Line?
The Blue Care Line is a 24 hour nurse line to answer your health care questions.
Enrollment & Eligibility
Who is eligible for the plan?
Enrollment in a health insurance plan is required for all students at Merrimack College. To ensure compliance with this policy, students (as defined below), are automatically enrolled in and billed for the Student Blue Plan unless proof of comparable insurance coverage is documented. Documentation is provided by completing a waiver form identifying the in-force comparable coverage and submitting it by the posted deadline. If a form is not submitted by the deadline, the student will remain enrolled in the Student Blue Plan for the policy year.
- All full-time and three quarter time students, as defined by the school, will be automatically enrolled in and billed for the Merrimack College Student Blue Plan. Eligible dependents of insured students can also be enrolled in the Merrimack College Student Blue Plan for an additional cost.
How do I enroll?
All eligible students who do not submit an online waiver by the deadline will be automatically enrolled in the student insurance plan.
How do I enroll my eligible dependents?
Students must purchase coverage for their eligible dependent(s) at the same time as their own initial plan enrollment. Dependent coverage must be purchased for the same time period as the student’s period of coverage and cannot exceed coverage purchased by the student. For example, a student enrolled for annual coverage cannot purchase dependent coverage for the spring semester unless a qualifying event, as defined below, occurs.
Students can add eligible dependent(s) if they experience one of the following qualifying events: (a) marriage (b) birth of a child, (c) divorce, or (d) if the dependent is entering the country for the first time. If dependent enrollment meets one of these qualifying events, the Dependent Enrollment Form, supporting documentation and payment must be received by Gallagher Koster within 31 days of the qualifying event. If not received within 31 days of the qualifying event, the effective date of coverage will be the date this form and payment are received at Gallagher Koster. Once a dependent is enrolled, coverage cannot be terminated unless the student loses eligibility. Students can enroll their eligible dependents online for an additional premium by visiting www.gallagherkoster.com/Merrimack, selecting ‘Dependent Enroll’, and completing the form by the published deadline.
Can I waive the Student Blue Plan with any of the insurance plans offered through the Commonwealth Connector?
Students are not eligible for any of the subsidized Commonwealth Care programs and these programs cannot be used to waive the Student Blue Plan. Students are eligible for the insurance plans offered through Commonwealth Choice, but these plans should be reviewed carefully as they may have very high deductibles and often times limited benefits.
Is there anything I need to know before waiving coverage?
Before waiving you should review your current policy, considering the following:
- Will your current plan cover medical care beyond emergency services (i.e. doctor’s office visits, diagnostic testing, x-rays,prescription drugs, mental health, etc.) in the North Andover, MA area?
- Does your plan have doctors and hospitals in the North Andover, MA area?
- Check the cost — is the annual cost of this Student Plan less expensive than the cost of being added as a dependent to your parents’ plan? Be sure to compare deductibles and total out-of-pocket costs, not just the annual premium.
- Are there administrative pre-requirements, pre-certification, or Primary Care Physician referrals required under your current plan that may delay receipt of care?
What about Health Care Reform? How does that affect my Student Blue Plan?
If you are under the age of 26, you MAY be eligible to enroll as a dependent under the employer health insurance plan held by your
parent(s). However, before you do so, you should fully compare the employer plan against this Student Plan to determine which plan’s rates, benefits and coverage are most appropriate for you. In addition to the items mentioned above, keep in mind that Student Insurance Plans are generally less expensive than individual plans with similar benefits. In fact, your total out-of-pocket cost (including premium and deductibles) may be significantly LESS with this Student Plan, especially if your parents’ employer plan is considered a ‘high deductible’ plan.
How do I waive coverage under the Student Blue Plan?
If you determine your coverage to be comparable and would like to waive the Student Blue Plan:
1. Go to www.gallagherkoster.com/Merrimack.
2. Click on the ‘Student Waive’ link.
3. Create a user account, or log in if you are a returning user.
4. Select the Red ‘I Want to Waive’ button. When waiving the insurance, have your current health insurance ID card ready as you will need this information in order to complete the waiver form. Upon completing the form, you will be asked to review your information for accuracy and then click ‘submit’. Immediately upon submitting your online form you will receive a confirmation number. Receipt of this confirmation number only confirms submission, not acceptance, of your Waiver Form. Please save this number and print a copy of the confirmation for your records.
Insurance Plan Benefits
What changes have been made to the plan for the 2013-2014 Policy Year?
- The 2013-2013 Student Health Insurance Plan will be offered by Blue Cross Blue Shield of Massachusetts/
- The Student Blue Plan has no maximum benefit.
- There is a $100 combined In Network and Out-of-Network per policy year deductible
- The Out-of-Pocket maximum is $5,000 per member; $10,000 per family, In-Network and Out-of-Network combined.
- The Preferred Provider Network is the BlueCare Elect PPO network.
What is covered under the Student Blue Plan?
- The plan offers comprehensive benefits that include hospital room and board, inpatient and outpatient surgical procedures, labs and x-rays, chemotherapy and radiation, inpatient and outpatient mental health services, physician office visits, consultant visits, ambulance, emergency care and prescription drugs.
- Preventive Care Services are available to cover routine physicals and examinations, routine screenings, routine GYN examinations, and most immunizations with no cost sharing for a student when services are received by In-Networkproviders.
- The Merrimack College BCBS Student Blue Plan has no maximum benefit, however there may be expense limitations within the plan. As a result students should refer to their brochure schedule for details.
- Services provided by a participating network provider are generally covered at 90%, while services provided by a nonnetwork provider are generally covered at 70%.
- Please refer to the plan brochure available at www.gallagherkoster.com/Merrimack by clicking on ‘My Benefits and Plan Information’ for complete details about coverage, limitations, and exclusions.
How much does the plan cost?
Student Only $1,520 Annual (8/3/13-8/12/13) $864 Spring (1/24/13-8/12/14)
Spouse Only $2,848 Annual (8/3/13-8/12/13) $1,606 Spring (1/24/13-8/12/14)
Child(ren) $2,173 Annual (8/3/13-8/12/13) $1,245 Spring (1/24/13-8/12/14)
How do I get my prescriptions filled?
- Prescriptions can be filled at an Express Scripts participating pharmacy. To find a list of participating pharmacies near you,visit www.express-scripts.com.
- At designated Express Scripts pharmacies you will pay a $10 copayment for a 30-day supply of a Tier-1 drug, a $25 copayment for a 30-day supply of a Tier-2 drug, and a $45 copayment for a 30-day supply of a non-preferred brand Tier-3 drug, with no maximum benefit amount.
- Prescriptions are also available through a Mail Service Program. Through the Mail Service Program you will pay 2x the cost of a 30-day supply for a 90-day supply of your prescription drug. Click on ‘Pharmacy Program’ at www.gallagherkoster.com/Merrimack to learn the details of the pharmacy program, including the Mail Service Program.
- Students who take maintenance drugs are encouraged to use the Mail Service Program to be able to receive the maximum benefit available.
- Outpatient medications for treatment of a Covered Expense are covered prescriptions. If the treatment of a medical condition is limited or excluded from the plan, the outpatient prescription is likewise limited or excluded.
- Students who are studying or traveling abroad and need more than a 30-day supply of their prescription may fill out a Prescription Override form by visiting www.gallagherkoster.com/Merrimack and selecting ‘Pharmacy Program’, then ‘Pharmacy Override Form’.
- Some prescription drugs require Prior authorization from BCBS or are part of the Step Therapy program.
- Prescriptions that require prior authorization need to be approved in advance by BCBS before you can fill you prescription. Your medical provider needs to complete a Prior Authorization form and send it to BCBS. To find out which prescriptions require prior authorization and to download the form, go to http://www.bluecrossma.com/pharmacy.
Am I covered if I have a pre-existing condition?
Yes, pre-existing conditions are covered immediately with no waiting periods or limitations.
Am I required to get a referral from my school’s Health Services before I seek treatment?
No, a referral is not required with the Student Blue Plan but there are many benefits to first seeking care or advice from Hamel Health Center. Students should be aware that on-campus Health Services are available to them. Your school’s Health Services website is: http://www.merrimack.edu/life/health_and_wellness/.
Do I get an ID Card?
ID Cards will be mailed to your home address. International Students should contact the Student Accounts Office after August 5th to obtain your ID Card.
Does this plan cover me when I am off campus, traveling or studying abroad?
Yes, the Student Blue Plan covers you during semester breaks, summer vacation and even if you’re traveling or studying abroad. You’ll be covered for the period for which you paid premium.
In addition to being covered for medical treatment and services, 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. All services must be arranged for in advance and provided by On Call International. Any services not arranged by On Call International will not be considered for payment.
- When studying or traveling abroad, keep your Student Blue Plan identification card with you and take a copy of the brochure for reference.
- When outside of the United States, you will likely be asked to pay for your medical care first and will then need to seek reimbursement. Covered Expenses will be reimbursed on an Out-of-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.
- Please ensure that your name, ID number, address (to receive your reimbursement check), and the College’s name are on the bill.
What is a deductible? Does this plan have a deductible?
A deductible is the amount for which you are responsible before payment is made by the claims company. Once you have paid the deductible, whether it’s applied to one service or multiple services, the plan will pay for covered medical expenses as indicated in the plan brochure. This plan has a $100 per member per plan year deductible that applies for in-network and out-of-network benefits combined.
Finding a Provider
Can I go to any doctor or hospital?
Yes, you can go to any provider; however, you will save money by seeing providers that participate in the BlueCare Elect PPO because providers participating in this network have agreed to accept a predetermined negotiated amount, or Preferred Allowance, as payment for their services.
Go to www.gallagherkoster.com/Merrimack and click on ‘Find a Doctor’ to locate participating providers.
What should I do if I receive a bill, or need to be reimbursed, for services I received?
Physicians should bill the claims administrator. The billing information is on the back of your health insurance ID card. However, if you do receive a bill or if you have paid for a service and need to be reimbursed, please send your bill (and proof of payment if seeking reimbursement) to the claims administrator. You do not need an additional claim form. Make sure your name, health insurance ID number, and school name are on the bill. Make a copy for your records before sending to the claims administrator at the following address:
For services received on or after August 13, 2013:
BlueCross BlueShield of Massachusetts
For services received prior to August 12, 2013:
Klais & Company, Inc.
1847 West Market Street
Akron, OH 44313
Is any other information needed in order to pay a claim?
If the treatment you received was a result of an accident, you will receive a letter from the claims administrator asking for information about the accident, i.e. was it the result of a car accident, from playing sports, etc. Your claim cannot be processed without this information, so please respond to the letter promptly. You may also receive a letter asking if you are covered by any other health insurance plan. It is important that you respond promptly to this as well.
How will my claims be paid if I have other health insurance in addition to the Student Blue Plan?
The Student Blue Plan has a coordination of benefits provision. This means your plan with Gallagher Koster will coordinate the payment of claims with your other insurance company. You will need to provide the claims company with information about your other health insurance company.
Please refer to your brochure for details.
What enhancements are available under this plan?
Exclusively from Gallagher Koster, enrolled students have access to a menu of products at no additional cost. More information is available by visiting www.gallagherkoster.com/Merrimack and clicking on the ‘Discounts and Wellness’ link.
Will I be covered under the plan after I graduate?
Yes, you will be covered under the Student Blue Plan until the end of the period for which you have purchased coverage.
Can I continue coverage after the policy terminates?
Yes, there is a non-group Conversion Plan offered through BlueCross BlueShield for MA residents call BlueCross BlueShield‘s member services at 800-422-3545 for more information and to enroll.
Are there any additional insurance products available?
Please visit www.gallagherkoster.com/Merrimack and click on the ‘Other Insurance Products’ link for complete details about additional insurance products that are available as well as enrollment information.
This document is only a summary of the benefits available. Please refer to the Summary Plan Description for a description of the
benefits available and exclusions and limitations of the plan.