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Home > College Offices > Health Services > Student Health Insurance > FAQ Regarding the Student Health Insurance Plan
FAQs - Regarding the Student Health Insurance Plan
This information should be used in conjunction with the Student Health Insurance Brochure.
How do I know if I am eligible to enroll in the Injury and Sickness Plan?
All full time and fellow students are eligible to enroll in the Student Health Insurance Plan. Frances Perkins, graduate students and special students who are carrying two or more courses for academic credit are also eligible. Only students who are officially enrolled at the Mount Holyoke Campus or are receiving academic credit in a MHC sponsored off-campus program can participate. Students who are on leave from the college at the beginning of the new plan year are not eligible for participation but may apply for participation after they have resumed active full time status with the college.
What’s covered under the Student Health Insurance Plan?
The Student Health Insurance Plan is offered through the college to provide basic medical coverage to eligible students who are sick or injured. The plan covers accident and sickness expense including hospital room and board, prescription drugs, emergency outpatient care, lab and x-rays, inpatient and outpatient surgical procedures, and physician office visits. Coverage varies from 70% to 100% depending on whether or not you seek benefits through an in-network or out-of-network provider. Coverage is subject to the limitations and provisions of the policy. Please refer to the brochure for exclusions and limitations.
This coverage is separate and complements the services provided at the Student Health Center.
What’s the difference between the Prepaid On-Campus Health Care Option and the Student Health Insurance Plan?
These are separate options. The Student Health Plan is comprised of the Student Health Insurance Plan and the Prepaid On-Campus Health Care Option. You can waive the Student Health Plan but still enroll in the Prepaid On-Campus Health Care Option that will provide you access to the range of services the Health Center offers and when it is open during the academic year.
Can I go to any health care provider?
You can, but there is a financial benefit to receiving care through a Network Provider. When students see a Network Provider, the insurance will cover 100% of a Preferred Allowance for covered expenses. Services rendered by a Non-Network Provider are covered at 70% of Usual and Customary charges. Network Providers have agreed to accept as payment in full for covered expenses, a prearranged amount or Preferred Allowance. A Non-Network Provider has not agreed to any prearranged fee schedule, and any charges in excess of the insurance payment will be your responsibility.
Do I have to get a referral before going to a doctor outside of the Student Health Center or the hospital?
You need to obtain a referral from the Student Health Center before seeking treatment by either a Network or Non-Network Provider. If you seek medical treatment from a Network Provider, the plan will cover most covered expenses at 100%. If you are treated by a Non-Network Provider, the plan will cover most covered expenses at 70%. There are exceptions to the referral process: when the Student Health Center is closed, during term breaks, when you are more than 50 miles from campus, and in the case of an emergency. Please review brochure for details on deductibles and co-pays.
Am I covered for a pre-existing condition?
There is a six-month waiting period before your pre-existing condition is covered if you are newly enrolled in the plan. However, if you were previously covered by another insurance plan for at least six months, and there was not a break in coverage of more than 30 days between your previous coverage and the Student Health Insurance Plan, your pre-existing condition will be covered. If you had previous coverage but it was for less than six months, the number of months you were covered will be applied to the waiting period. If you didn't have previous coverage or you had a break in coverage for more than 30 days, then your pre-existing coverage will be covered up to $2,500 for the first six months under the Student Health Insurance Plan. After 6 months of coverage under the Student Health Insurance Plan, your condition will be covered.
How are prescriptions filled?
The Prescription Program is available through Express Scripts Pharmacy Network. There is a $10 co-payment for a generic drug, a $25 co-payment for a brand name drug and a $45 co-payment for a non-formulary drug for each 30-day supply. After the co-payment, the prescription will be covered at 100% up to a maximum of $1500 per policy year. Present your ID card to the pharmacist when purchasing your prescription. To locate a participating pharmacy, call Pioneer Management Systems at 877-868-9060. Not all prescription drugs are covered. Please refer to the brochure for more details.
When I receive services, how and where do I submit my bill?
You do not need a claim form to submit a bill. Physicians can bill the administrator, Pioneer Management Systems, Inc. directly. If you receive a bill or need reimbursement, you can also forward your bill or your request for reimbursement to Pioneer Management Systems, Inc. at the address below. Make sure your name, ID number, address and the College’s name are on the bill. All provider bills must be sent to:
Pioneer Management Systems, Inc.
330 Whitney Avenue
Holyoke, MA 0140
1-877-868-9060
email
Where and when will ID Cards be distributed?
Each student purchasing the Student Health Insurance Plan will receive an insurance ID Card in her mailbox when she arrives on campus. Please carry the ID card at all times and you must present it whenever receiving medical care or filling a prescription. If you need to see a doctor before you receive your ID card, tell the provider that you covered under the Mount Holyoke College student health insurance program. Your provider can always call Gallagher Koster Insurance to verify eligibility at 800-457-5599.
What if I leave Mount Holyoke College, will I get a refund?
Once you attend classes for 31 days, your coverage will be in effect for the full period for which premiums were paid and you will not be given a refund. You can request a refund for second semester coverage period.
Does the Student Health Insurance Plan cover me if I decide to study abroad?
Yes, the Student Health Insurance Plan provides worldwide coverage, whether studying or traveling abroad. The plan provides the same benefits as if you were at Mount Holyoke College.
Who do I call if I have questions about enrollment, eligibility, coverage or other service issues?
Gallagher Koster Insurance Agency
500 Victory Road, Quincy, MA 02171
800-457-5599
email
Who do I call if I have questions about a specific claim or claims payment?
Pioneer Management Systems, Inc.
330 Whitney Avenue, Holyoke, MA 01040
877-868-9060
email
Who do I call if I need help in finding an in-network or preferred provider?
Contact:
To find a Pioneer PPO provider:
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