You are eligible to enroll in one of several plans with Tufts Health Plan. All plans satisfy the coverage requirements of both federal and Massachusetts health care reform laws. For most eligible faculty and staff, Berklee subsidizes the cost of coverage by paying 65 percent of the premium, while you pay the remainder through pre-tax payroll deductions via Berklee's Section 125 Cafeteria Plan.
Berklee's coverage with Blue Cross Blue Shield of Massachusetts ended on December 31, 2012. For questions or concerns about coverage with Blue Cross, call 888 543-8770.
Medical and Dental Plan Rates
This is a comprehensive plan in which you choose a primary care provider (or PCP) who will coordinate your medical care within the HMO's network and provide referrals as needed. There are no benefits for health care outside of the New England network except for emergency and urgent care.
During personal travel outside of the New England network, you may need to pay for emergency or urgent care and then apply for reimbursement from the plan.
Contact the Office of Human Resources about health care outside of the New England network during Berklee business travel.
You have a choice with this health insurance option. The PPO plan provides a higher level of benefit (in-network) if you use health care providers in Tufts Health Plan's network, and a lower level of benefits if you use non-network providers. You do not need to name a primary care provider (PCP) or receive referrals for specialist visits. This freedom of choice comes at the cost of a higher premium for than you would pay under the HMO option.
During personal travel outside of the New England area, you may need to pay for health care costs and then apply for reimbursement from the plan.
Contact the Office of Human Resources about health care outside of New England during Berklee business travel.
The new high-deductible PPO plan contains some similarities to and some differences from the current PPO plan. The main similarity is the freedom to choose your own doctors inside and outside of the Tufts network.
The differences include the fact that the high-deductible PPO has a larger up-front deductible, but almost no copayments once the annual deductible for medical services has been satisfied; however, prescriptions continue to have copayments.
The high-deductible plan is accompanied by a health savings account (HSA) that allows you to put money aside, before income taxes, to pay for all of your medical expenses using pre-tax dollars.
An HSA allows dollars to "roll over" from one year to the next and provides tax advantages: contributions are made before income taxes, balances grow tax-free, and all withdrawals for qualified medical expenses are tax-free. The tables below offer a quick comparison of the PPO plan and the high-deductible PPO plan, as well as a look at some of the kinds of expenses that you may have to cover out-of-pocket prior to meeting the higher deductible of the new high-deductible PPO plan.
For more information about the HSA, visit WageWorks.
Enrollment and Member Services
When to Enroll
You may enroll yourself and eligible family members within 30 calendar days of your hire date (or if later, the date you become eligible for coverage). If you miss this deadline, your next opportunity to enroll will be during the annual open enrollment period (typically in the fall). Open enrollment changes become effective on January 1 of the upcoming calendar year.
Family members you may enroll are:
- Your spouse (legally married, same or opposite sex). A copy of your marriage certificate is required.
- Your same-sex domestic partner (if you live in a jurisdiction where you cannot marry). An affidavit of domestic partnership is required.
- Your children under age 26. A copy of the birth certificate or similar document is required.
Special rules apply to certain children who are not your children by birth and to ex-spouses after divorce. Contact the Office of Human Resources for more information.
Enrollment Effective Date
The enrollment effective date is the first day of the month following your hire date (or, if later, the date you become eligible for coverage).
When to Start Using Your Medical Insurance ID Card
You will receive health insurance ID cards from Tufts Health Plan approximately three to four weeks after you have completed the enrollment process. As a result, although your coverage will be effective the first of the month, you might not receive your cards until later. If possible, contact Tufts Health Plan member services before scheduling your first appointment. If you need health care services before you receive your insurance ID card, you and your doctor may contact Tufts Health Plan for proof of coverage. In an emergency, seek treatment immediately.
Changing Your Coverage
Except during your initial 30-day enrollment period or during annual open enrollment, federal regulations prohibit you from enrolling in, canceling, or changing your participation in the plan unless you experience a qualifying life event. Examples of these events include marriage, divorce, birth of a child, and loss of non-Berklee insurance. Any change must be consistent with your qualifying life event. The deadline for making these changes is 30 days from the date of the event.
When Coverage Ends
Generally, insurance coverage for you and your covered family memebers ends at the end of the month when your employment (or eligibility) ends. However, your children's coverage could end sooner. The last day of coverage for children is the day before their 26th birthday, unless they are certified as disabled and eligible for continued coverage. Any person whose coverage ends is eligible to continue that coverage for a period of time via COBRA. Additional COBRA information can be found here.
Taxes and Health Insurance: Massachusetts Residents' Form 1099-HC
Massachusetts law requires Massachusetts residents over the age of 18 to prove that they have health care coverage or pay a tax penalty. Massachusetts residents are required to transcribe data contained on form 1099-HC to their Massachusetts tax returns. By January 31 of each year, our insurance company will issue 1099-HC forms to Massachusetts residents who were enrolled in Berklee medical insurance at any time during the prior calendar year.
Tufts Health Plan Member Services
HMO: 800 462-0224
Carelink PPO (including High Deductible PPO): 866 352-9114