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MHC Comparison of the College-Sponsored Health Insurance
Plans PDF version
of this document Please click on the topic of your choice and it will bring you to that specific information. Note: This summary of Health Insurance benefits is not a contract. Please see individual Subscriber Certificates for details. * out of network charges subject to annual deductible and reasonable and customary charge limitations |
| Hospital/Inpatient |
| Conditions of Coverage | HMO Blue | Blue Choice |
Blue Choice New England Out-of-Network Self Referred |
Blue Care Elect Preferred PPO |
Blue Care Elect Preferred PPO Out-of-Network |
| 1. Semi-private Room (medically necessary) | Covered in full after a $250 co-payment per admission | Covered in full after a $250 co-payment per admission | Covered at 80% after deductible.* | Covered in full after inpatient co-payment of $250 per admission | Covered at 80% after deductible* |
| 2. Private Room | Covered in full after a $250 co-payment per admission when medically necessary and authorized by an HMO Blue physician. | Covered in full after a $250 co-payment per admission when medically necessary and authorized by plan physician. | Covered at 80% after deductible.* | Covered in full, up to semi-private room rate, after a $250 co-payment per admission when medically necessary and authorized by plan physician. |
Covered at 80% after deductible.* |
| 3. Surgery | Covered in full after a $250 co-payment per admission | Covered in full after a $250 co-payment per admission. | Covered at 80% after deductible.* | Covered in full after a $250 co-payment per admission | Covered at 80% after deductible.* |
| 4. Hospital Services (including nursing care, operating room, anesthesia, drugs, and x-rays) |
Covered in full after a $250 co-payment per admission | Covered in full after a $250 co-payment per admission | Covered at 80% after deductible.* | Covered in full after a $250 co-payment per admission | Covered at 80% after deductible.* |
| 5. Physicians' and Consultants' Services | Covered in full. | Covered in full. | Covered at 80% after deductible.* | Covered in full. | Covered at 80% after deductible.* |
| 6. Intensive Care (coronary, etc.) |
Covered in full after a $250 co-payment per admission | Covered in full after a $250 co-payment per admission | Covered at 80% after deductible.* | Covered in full after a $250 co-payment per admission | Covered at 80% after deductible.* |
| 7. Extended Care Facility | Covered in full when arranged by an HMO Blue physician, up to 100 days per calendar year. | Covered in full when arranged by a Blue Choice physician, up to 100 days per calendar year. | Covered at 80% after deductible up to a maximum of 100 days.* | Covered in full up to 100 days per calendar year | Covered at 80% after deductible up to a maximum of 100 days* |
| Maternity |
| Conditions of Coverage | HMO Blue | Blue Choice |
Blue Choice New England Out-of-Network Self Referred |
Blue Care Elect Preferred PPO |
Blue Care Elect Preferred PPO Out-of-Network |
| 1. Pregnancy Complications | Covered in full. | Covered in full. | Covered at 80% after deductible.* | Covered in full. | Covered at 80% after deductible.* |
| 2. Prenatal and Post-partum Checkups | Covered in full. |
Covered in full. |
Covered at 80% after deductible.* |
Covered in full. |
Covered
at 80% after deductible.* |
| 3. Delivery and Nursery | Covered in full after inpatient co-payment of $250 | Covered in full after inpatient co-payment of $250 | Covered at 80% after deductible.* | Covered
in full after inpatient co-payment of $250 |
Covered
at 80% after deductible.* |
| 4. Newborn Checkups | $15.00 per visit. | $15.00 per visit. | Covered at 80% after deductible.* | $15.00 per visit. | Covered at 80% after deductible.* |
| 5. Childbirth Education | $90.00
initial course. $45.00 refresher. |
$90.00
initial course. $45.00 refresher. |
$90.00
initial course. $45.00 refresher. |
$90.00
initial course. |
$90.00
initial course. $45.00 refresher. |
| Office Visits/Outpatient |
| Conditions of Coverage | HMO Blue | Blue Choice |
Blue Choice New England Out-of-Network Self Referred |
Blue Care Elect Preferred PPO |
Blue Care Elect Preferred PPO Out-of-Network |
| 1. Periodic Physical Exam | $15.00 per PCP visit.
$25.00 per Specialist visit. Difference in copayment Is based on PROVIDER. |
$15.00 per PCP visit.
$25.00 per Specialist visit. Difference in copayment Is based on PROVIDER. |
Routine physical exam covered at 80% after deductible. Mammograms covered at 80% after deductible. Annual gynecological exam including pap smear covered at 80% after deductible.* | $15.00 per visit |
Covered at 80% after deductible. Age based schedule followed |
| 2. Well Baby Care | $15.00 per PCP visit.
$25.00 per Specialist visit. Difference in co-payment Is based on PROVIDER. |
$15.00 per PCP visit.
$25.00 per Specialist visit. Difference in co-payment Is based on PROVIDER. |
Covered at 80% after deductible up to age six.* (Includes immunizations) | $15.00 per visit (no costs for routine tests) Age based schedule followed: 10 visits during 1st yr 3 visits during 2nd yr 1 visit / cal yr age 2-11 1 visit / 2 cal yrs age 12-18 |
Covered at 80% after deductible. Age based schedule followed |
| 3. Immunizations | $15.00
per PCP visit. $25.00 per Specialist visit. Allergy shots – covered in full. |
$15.00
per PCP visit. $25.00 per Specialist visit. Allergy shots – covered in full. |
Covered at 80% after deductible.* | $15.00 per visit. Allergy shots $15.00 co-payment- separate from the office visit copayment |
Covered at 80% after deductible. |
| 4. Diagnostic X-ray and Lab | Covered in full. | Covered in full. | Covered at 80% after deductible.* | Covered in full. | Covered at 80% after deductible.* |
| 5. Minor Surgery | $15.00 / $25.00 for office visit surgery Covered in full in hospital surgical day care facility. Covered
in full after $250 co-payment when inpatient. |
Covered
in full in office or hospital surgical day care facility.
Covered
in full after $250 co-payment when inpatient. |
Covered at 80% after deductible.* | $15.00 per visit in office setting |
Covered at 80% after deductible.* |
| 6. Allergy Tests | $25.00 per visit. Injections only are covered in full |
$25.00 per visit. Injections only are covered in full |
Covered at 80% after deductible.* | $15.00 per visit
$15.00 for allergy injection per visit - separate from the office visit copayment |
Covered at 80% after deductible.* |
|
7. Eye and refraction |
$25.00 per visit Self-referral once every calendar year to any HMO Blue network provider. |
$25.00 per visit Self-referral once every calendar year to any Blue Choice Network provider |
Covered at 80% after deductible.* | $15.00 per visit Once every calendar year |
Covered at 80% after deductible. |
| 7b. Routine Hearing Exams | $15.00 per visit by PCP $25.00 per visit by other network providers. |
$15.00 per visit by PCP $25.00 per visit by other network providers. |
Covered at 80% after deductible.* | $15.00 per visit. | Covered at 80% after deductible. |
| 8. House Call | Covered in full when arranged by primary care physician. | Covered in full when arranged by primary care physician. | Covered at 80% after deductible when medically necessary.* | $15.00 per visit | Covered at 80% after deductible. |
| 9. Radiation Therapy | Covered in full. | Covered in full. | Covered at 80% after deductible.* | Covered in full. | Covered at 80% after deductible.* |
| 10. Physical Therapy | $25.00 per visit up to 60 visits per calendar year for each unrelated illness or injury. | $25.00 per visit up to 60 visits per calendar year for each unrelated illness or injury. | Covered at 80% after deductible up to 60 visits per calendar year for each unrelated illness or injury.* | $15.00 per visit up to 100 visits per calendar year for each unrelated illness or injury. | Covered at 80% after deductible.* |
| 11. Prescription Drugs | $10.00
generic $20.00 brand $35.00 non-preferred up to a 30 day supply. Mail order: |
$10.00
generic $20.00 brand $35.00 non-preferred up to a 30 day supply. Mail order: |
No coverage for use of non-participating pharmacies. (94% of pharmacies across United States participate with BC/BS). Reimbursement for out-of-country prescriptions by submitting claim forms. |
$10.00 generic Mail order:
|
No coverage for use of non-participating pharmacies. (94%
of pharmacies across the United States participate with BC/BS). Reimbursement for out of country prescriptions by submitting claim forms. |
| 12. Specialist Visits | $25.00 per visit. | $25.00 per visit. | Covered at 80% after deductible.* | $15.00 per visit. | Covered at 80% after deductible.* |
| 13. Chiropractic Service | Not covered. |
$25.00 per visit. | Covered at 80% after deductible.* |
$15.00 per visit |
Covered at 80% after deductible. |
| 14. Acupuncture and Homeopathy | Living Healthy Naturally program – offers discounts up to 30% | Living Healthy Naturally program – offers discounts up to 30% | Living Healthy Naturally program – offers discounts up to 30% | Living Healthy Naturally program – offers discounts up to 30% | Living Healthy Naturally program – offers discounts up to 30% |
| Family Planning |
| Conditions of Coverage | HMO Blue | Blue Choice |
Blue Choice New England Out-of-Network Self Referred |
Blue Care Elect Preferred PPO |
Blue Care Elect Preferred PPO Out-of-Network |
| 1. Office Visit | $15.00 per visit. | $15.00 per visit. | Covered at 80% after deductible.* | $15.00 per visit. | Covered at 80% after deductible. |
| 2. Sterilization | $15.00 if done in office. Covered in full at facility. | $15.00 if done in office. Covered in full at facility. | Covered at 80% after deductible.* | $15.00 if done in office. Covered in full at facility. | Covered at 80% after deductible. |
| 3. Termination of Pregnancy | $15.00 if done in office. Covered in full at facility. | $15.00 if done in office. Covered in full at facility. | Covered at 80% after deductible.* | $15.00 if done in office. Covered in full at facility.
|
Covered at 80% after deductible. |
| 4. Infertility Services | $15.00 if done in office. Covered in full at facility. | $15.00 if done in office. Covered in full at facility. | Covered at 80% after deductible.* | $15.00 per visit | Covered at 80% after deductible.* |
| Dental |
| Conditions of Coverage | HMO Blue | Blue Choice |
Blue Choice New England Out-of-Network Self Referred |
Blue Care Elect Preferred PPO |
Blue Care Elect Preferred PPO Out-of-Network |
| 1. Preventive Care | Full coverage for preventative dental care for children through age 11. Includes cleaning, x-rays and fluoride treatment 1 every 6 months. | Not covered. | Not covered. | Not covered. | Not covered. |
| 2. Other Services | Coverage is provided for extraction of teeth imbedded in the bone in the dentist office or surgical day care center by a network physician | Coverage is provided for extraction of teeth imbedded in the bone in the dentist office or surgical day care center by a network physician | Covered at 80% after deductible. | Not covered. | Not covered. |
| Urgent, Emergency, and out of Plan/Area Care |
| Conditions of Coverage | HMO Blue | Blue Choice |
Blue Choice New England Out-of-Network Self Referred |
Blue Care Elect Preferred PPO |
Blue Care Elect Preferred PPO Out-of-Network |
| 1. In the Area | $15.00 per office visit for PCP. $25.00 for specialist. $75.00 co-payment at emergency room, waived if admitted and a $250 inpatient co-payment applies. Plan must be notified within 48 hours. |
$15.00 per office visit for PCP. $25.00 for specialist. $75.00 co-payment at emergency room, waived if admitted and a $250 inpatient co-payment applies. Plan must be notified within 48 hours.
|
Covered at 80% after deductible.* | $15.00 per office visit. $75.00 co-payment at emergency room, (waived if admitted or for observation stay)and a $250 inpatient co-payment applies. | $75.00 co-payment at emergency room, (waived if admitted or for observation stay) and a $250 inpatient copayment. No deductible. |
| 2. Out of the Area/ State/ Country | $75.00 co-payment when hospital emergency room is utilized for emergency or urgent care. The co-payment is waived if the emergency room visit results in an admission and a $250 inpatient co-payment applies. The plan must be notified within 48 hours. | $75.00 co-payment when hospital emergency room is utilized for emergency or urgent care. The co-payment is waived if the emergency room visit results in an admission and a $250 inpatient co-payment applies. The plan must be notified within 48 hours. | Covered at 80% after deductible.* | $75.00 co-payment when hospital emergency room is utilized for emergency or urgent care. The co-payment is waived if the emergency room visit results in an admission and a $250 inpatient co-payment applies. | Covered at 80% after deductible.* |
| 3. Ambulance | Covered in full when authorized by plan physician or life-threatening emergency. | Covered in full when authorized by plan physician or life-threatening emergency. | Covered in full. | Covered in full | Covered at 80% after deductible. |
|
4. Out of Plan Care. a. Non-Participating Physicians |
(a and b) All medical services available on referral through primary care physician in HMO Blue medical group. Decision to use non-referred care will be at member's expense. Urgent care while outside of member's health center service area is covered same as out of state care. | (a and b) All medical services available on referral through primary care physician in Blue Choice NE medical group. Urgent care while outside of member's health center service area is covered same as out of state care when PCP approved. | Member
can self-refer to participating provider of their choice. Benefits will
be subject to deductible and coinsurance limits. Participating physicians
may not balance bill beyond the BCBSMA approved amount.
|
Can see any BC/BS PPO national provider | Member can see non-BC/BS PPO provider. Benefits will be subject to deductible and co-insurance limits. Balance billing may occur. |
| b. Non-Participating Facilities | (a and b) All medical services available on referral through primary care physician in HMO Blue medical group. Decision to use non-referred care will be at member's expense. Urgent care while outside of member's health center service area is covered same as out of state care. | (a and b) All medical services available on referral through primary care physician in Blue Choice NE medical group. Urgent care while outside of member's health center service area is covered same as out of state care when PCP approved. | Benefits available only from participating facilities (Every hospital in Massachusetts participates with BC/BS.) Facilities outside of Massachusetts may balance bill the entire amount beyond BC/BS payment. | Can see any BC/BS PPO national provider | Member can see non-BC/BS PPO provider. Benefits will be subject to deductible and co-insurance limits. Balance billing may occur. |
| Health Education |
| Conditions of Coverage | HMO Blue | Blue Choice |
Blue Choice New England Out-of-Network Self Referred |
Blue Care Elect Preferred PPO |
Blue Care Elect Preferred PPO Out-of-Network |
| 1. Patient Education | Helping
members stay informed, healthy: bcbsma.com Ahealthyme.com Drugstore.com |
Helping
members stay informed, healthy: bcbsma.com Ahealthyme.com Drugstore.com |
Helping
members stay informed, healthy: bcbsma.com Ahealthyme.com Drugstore.com |
Helping
members stay informed, healthy: bcbsma.com Ahealthyme.com Drugstore.com |
Helping
members stay informed, healthy: bcbsma.com Ahealthyme.com Drugstore.com |
| Mental Health |
| Conditions of Coverage | HMO Blue | Blue Choice |
Blue Choice New England Out-of-Network Self Referred |
Blue Care Elect Preferred PPO |
Blue Care Elect Preferred PPO Out-of-Network |
| 1. Hospitalization | Covered in full up to 60 days per calendar year in a psychiatric hospital, unlimited days in a general hospital. No limit for Biology based conditions after a $250 co-payment per admission | Covered in full up to 60 days per calendar year in a psychiatric hospital, unlimited days in a general hospital. No limit for Biology based conditions after a $250 co-payment per admission | Covered at 80% after deductible* up to a maximum of 60 days (less any benefits provided in-network). In a licensed general hospital, covered as any other illness. |
Covered in full up to 60 days per calendar year in a psychiatric hospital, unlimited days in a general hospital. No limit for Biology based conditions after a $250 co-payment per admission. |
Covered at 80% after deductible* up to a maximum of 60 days (less any benefits provided in-network). In a licensed general hospital, covered as any other illness. |
| 2. 24-hour Crisis Counseling |
Mental health care, alcohol / drug treatment care including crisis intervention and evaluation. |
Mental health care, alcohol / drug treatment care including
crisis intervention and evaluation. Biologically – based conditions outpatient visits $15.00 per visit. Non-Biologically based conditions (Includes drug addiction and alcoholism) up to 24 visits per calendar year. $15.00 per visit. Alcoholism treatment up to 8 additional visits per calendar year. $15.00 per visit.
|
Covered
at 80% after deductible* (less any benefits provided in-network).
Up to 24 visits per member per calendar year. |
Mental
health care, alcohol / drug treatment care including crisis intervention
and evaluation. Biologically – based conditions outpatient visits $15.00 per visit. Non-Biologically based conditions (Includes drug addiction and alcoholism) up to 24 visits per calendar year. $15.00 per visit. Alcoholism treatment up to 8 additional visits per calendar year. $15.00 per visit. |
Covered
at 80% after deductible* (less any benefits provided in-network).
Up to 24 visits per member per calendar year. |
| 3. Psychotherapy | Same as above. | Same as above. | Covered at 80% after deductible (less any benefits provided
in-network). Up to 8 visits per member per calendar year. |
Same as above. |
Same as above. |
| Alcohol/Drug Treatment |
| Conditions of Coverage | HMO Blue | Blue Choice |
Blue Choice New England Out-of-Network Self Referred |
Blue Care Elect Preferred PPO |
Blue Care Elect Preferred PPO Out-of-Network |
| 1. Emergency Care | Mental health care, alcohol/drug treatment care including crisis intervention and evaluation. | Mental health care, alcohol/drug treatment care including crisis intervention and evaluation. | Covered at 80% after deductible (less any benefits provided in-network). Up to 8 visits per member per calendar year. | Mental health care, alcohol/drug treatment care including crisis intervention and evaluation. | Covered at 80% after deductible (less any benefits provided in-network). Up to 8 visits per member per calendar year. |
| 2. Detoxification | Covered in full in a facility designated by HMO Blue for up to 30 days in a calendar year. Two days of outpatient treatment may be substituted for each inpatient day up to 60 days in a calendar year after a $250 co-payment per admission. Non-Biologically based
conditions up to 24 visits per calendar year.
|
Covered in full in a facility designated by Blue Choice for
up to 30 days in a calendar year. Two days of outpatient treatment may
be substituted for each inpatient day up to 60 days in a calendar year
after at $250 copayment per admission.
Non Biologically based conditions up to 24 visits per calendar year. |
Covered
at 80% after deductible less any benefits provided in-network.* In a
licensed general hospital covered as for any other illness. Up to 8 visits per member per calendar year. |
Covered in full in a facility designated by BC/BS PPO for up to 30 days in a calendar year. Two days of outpatient treatment may be substituted for each inpatient day up to 60 days in a calendar year after at $250 copayment per admission. Non Biologically based conditions up to 24 visits per calendar year.
|
Covered
at 80% after deductible less any benefits provided in-network.* In a
licensed general hospital covered as for any other illness. |
| 3. Rehabilitation | Same as above. | Same as above. | Covered
at 80% after deductible (less any benefits provided in-network). Up to 8 visits per member per calendar year. |
Same as above.
|
Covered
at 80% after deductible less any benefits provided in-network.* Up to 8 visits per member per calendar year. |
| Home Health Care |
| Conditions of Coverage | HMO Blue | Blue Choice |
Blue Choice New England Out-of-Network Self Referred |
Blue Care Elect Preferred PPO |
Blue Care Elect Preferred PPO Out-of-Network |
| 1. Visiting Nurse | Covered in full when arranged by HMO Blue. | Covered in full when arranged by PCP/Plan. | Covered at 80% after deductible.* | Covered in full | Covered at 80% after deductible.* |
| 2. Home Health Aide | Covered in full when arranged by HMO Blue. | Covered in full when arranged by PCP/Plan. | Covered at 80% after deductible.* | Covered in full | Covered at 80% after deductible.* |
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