Medical Plans
Northeastern provides benefits eligible faculty and staff with a high quality medical plan through Blue Cross Blue Shield (BCBS). A health maintenance organization (HMO) and a point-a-service (POS) plan are offered. Each plan provides comprehensive, preventive coverage through a large network of doctors and hospitals and there are no limitations for pre-existing conditions.
Medical premiums are paid using pre-tax payroll deductions and Northeastern shares the premium cost: The university pays 70 percent and you pay 30 percent. For the 2013 rates, please refer to the Rates Sheet (PDF).
Effective January 1, 2013, Preventive Services (PDF) such as adult and child routine physicals will have no co-pay.
Health Maintenance Organizations (HMO)
An HMO plan provides the most cost-effective coverage by contracting with providers to form physician networks. Under the HMO arrangement, you are required to use in-network providers and pay modest copayments when receiving care. This arrangement minimizes out-of-pocket expenses. It is important to remember that any medical services provided by a non-network physician will not be covered.
For more detailed information on the 2013 HMO plan coverages, please refer to the HMO Summary of Benefits (PDF) or Summary of Benefit Coverage (PDF).
Blue Choice New England
888.543.8770
www.bcbsma.com
Find A Doctor
Point-of-Service (POS)
With a Point of Service plan (POS), you decide how you want to balance choice and value every time you need care. A POS plan provides the flexibility to use your primary care physician or self refer to any Blue Cross Blue Shield participating provider. As long as your care is provided or arranged by your Blue Cross primary care physician, your out-of-pocket expenses will be minimal. You also have the freedom to seek care without seeing your PCP first. These are your self-referred benefits. When you self refer in Massachusetts, you may use any provider who participates with Blue Cross Blue Shield of Massachusetts. When you self refer outside of Massachusetts you may use any licensed provider. When you self refer your out-of-pocket cost will be greater. You are typically responsible for 20 percent coinsurance after the deductible, resulting in higher out-of-pocket costs. You may be subject to balance billing, claim form submission as well. Please call BCBSMA member service at 888.543.8770 for any further questions you may have regarding the use of your Blue Choice New England Plan.
For more detailed information on the 2013 POS plan coverages, please refer to the POS Summary of Benefits (PDF) or Summary of Benefit Coverage (PDF).
*Annual Deductible is $500 per individual and $1,000 per family, and the annual out-of-pocket maximum to employees is $1,000 per individual and $2,000 per family.
Blue Choice New England
888.543.8770
www.bcbsma.com
Find A Doctor
Preferred Provider Organization (PPO)
For employees permanently residing outside of the New England area, the Blue Care Elect Preferred PPO plan is available. A PPO plan allows you to seek services “in-network” and “out-of-network.” When using in-network benefits, provided by preferred providers, you are minimizing your out-of pocket expenses . Out-of-network benefits, provided by non-preferred providers, will result in higher out-of-pocket costs. You are typically responsible for 20 percent co-insurance after the annual deductible when out-of-network. This plan does not require you to select a primary care physician. Utilization Review is a requirement under this plan, meaning should you need non-emergency or non-maternity hospitalization you must call the number of your ID card for pre-approval. You can obtain provider directories at www.bcbsma.com or by calling Blue Cross Blue Shield’s member services department directly at 888.543.8770.
For more detailed information on the 2013 PPO plan coverages, please refer to the PPO Summary of Benefits (PDF) or Summary of Benefit Coverage (PDF).
*Annual Deductible is $500 per individual and $1,000 per family, and the annual out-of-pocket maximum to employees is $1,000 per individual and $2,000 per family.
Blue Care Elect Preferred
888.543.8770
www.bcbsma.com
Find A Doctor
Prescription Coverage
Prescription coverage is an important part of the Northeastern medical program and is provided automatically through BCBS. The prescription coverage is designed to assist in making the best decision by providing high-quality prescription drugs and cost-saving features, such as a Three-Tier Drug Classification and a Mail-Order Program.
Three-Tier Drug Classification
Each of the prescription plans consists of three drug classifications: generic, preferred brand and nonpreferred brand-name drugs. Generic drugs are the least expensive and include drugs that have not been assigned a brand name. Preferred brand-name drugs represent the less costly of the brand-name prescription drugs, while nonpreferred brand-name drugs are the most expensive. It is important to remember that many drugs in both the preferred and nonpreferred brand-name drug classifications have equivalent generic drugs available for greater cost savings.
The retail prescription costs for the HMO, POS, and PPO plans are listed below:
Retail Prescription Co-pays (Up to a 30-day supply)
| Prescription Drug Tier | 2012 Co-pays |
|---|---|
| Generic (Tier 1) | $5 |
| Preferred Brand Name (Tier 2) | $25 |
| Non-Preferred Brand Name (Tier 3) | $40 |
The mail-order prescription program allows for purchase of prescriptions in quantities for long-term use, typically up to a 90-day supply for a single copayment. If employees or their covered dependent(s) are on a maintenance prescription drug, or a drug taken consistently each month, taking advantage of the mail-order prescription program will further increase prescription savings.
The mail order prescription costs for the HMO and POS plans are listed below:
Mail Order Prescription Co-pays (Up to a 90-day supply)
| Prescription Drug Tier | 2012 Co-pay |
|---|---|
| Generic (Tier 1) | $10 |
| Preferred Brand Name (Tier 2) | $45 |
| Non-Preferred Brand Name (Tier 3) | $75 |
Blue Cross Blue Shield
Express Scripts
800.892.5119
www.bcbsma.com
Eligibility and Enrollment
For eligibility and enrollment criteria, please refer to the eligibility and enrollment guidelines.
If you are eligible and would like to enroll, complete a benefits enrollment form (PDF) and return it to HRM/Benefits at 250 Columbus Place. If you are enrolling for the first time, you and your covered dependent(s) must elect a PCP. To find a PCP please visit the BCBS Web site to Find a Doctor.
Massachusetts Health Care Reform
Effective July 1, 2007, the Massachusetts Health Care Reform law requires all Massachusetts residents who are 18 or older to have health insurance. If you decide to waive health insurance coverage, you will be required to complete a Commonwealth of Massachusetts Health Insurance Responsibility Disclosure Form (HIRD) (PDF) as part of the enrollment process. Click here for more information.
Federal Health Care Reform
Northeastern University believes the medical plans being offered to you in 2013 through BlueCross BlueShield of Massachusetts (BCBSMA) are "grandfathered health plans" under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your BCBSMA may not include certain consumer protections of the Affordable Care Act that apply to other plans. However, grandfathered healthy plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.
Questions regarding which protections apply and which protections do not apply to a grandfathered health plan, and what might cause a plan to change from grandfathered health plan status can be directed to Human Resources Management at 716 Columbus Avenue, Suite 250, Boston, MA 02120 / 617.373.2230. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 866.444.3272 or www.dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans.