Plan Coverage and Benefits
Berklee's Student Health Insurance Plan is offered through Blue Cross Blue Shield of Massachusetts (bluecrossma.com) and is administered by Gallagher Student Health & Special Risk (gallagherstudent.com), a leading provider of insurance services for institutions of higher learning in the U.S. The 2015-2016 Student Health Plan meets minimum creditable coverage standards for Massachusetts residents that went into effect as of January 1, 2014, as part of the Massachusetts Health Care Reform Law.
If you have signed up for the student insurance plan at any time during the fall 2015 – summer 2016 academic year, your insurance covers you from August 15, 2015 through August 14, 2016. This is true whether you are enrolled at Berklee, have since graduated, or left the college. This coverage also extends outside of the United States.
As a result of health care reform, Preventive Services have been further enhanced: Services that fall under the Preventive Health/Wellness Benefit are paid at 100% in-network only with no cost-sharing (no co-payments or deductibles). Preventive Health/Wellness Benefits include, but are not limited to, routine physicals and exams, routine GYN exams, preventive screening and testing, and most immunizations.
What Is Covered under the Blue Cross Blue Shield (BCBS) Student Blue PPO 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.
- There is no maximum benefit under the BCBS Student Blue PPO Plan.
- Pre-existing conditions are covered immediately like any other covered injury or sickness.
- Students have access to the BCBS nationwide network of preferred providers, pharmacy network, and other BCBS programs, such as the fitness benefit and reimbursement for designated weight loss programs.
- The pharmacy benefit program includes retail chains as well as independent pharmacies through the Express Scripts Network. (Click on "Prescription Drug Coverage" from the links at the left for more information.)
You can go to any provider; however, services provided by a participating in-network provider are generally covered at 100%, while services provided by an out-of-network provider are generally covered at 80% of the usual and customary charges. Benefit periods may vary (i.e., policy year vs. calendar year) per benefit. See the plan brochure for details. (Click on "Finding a Preferred Provider" from the links at the left for more information.)
For a detailed listing of plan benefits and out-of-pocket costs coverage, limitations, and exclusions, download the Berklee Student Health Plan: 2015-2016 Summary of Benefits.pdf
Whether you are on semester break, summer vacation, or even studying or traveling abroad, Berklee's Student Health Insurance Plan provides the same benefits as if you were on campus. You'll be covered for the period for which you paid the premium.
In addition to coverage for medical treatment and services, you will also be covered for Emergency Medical Evacuation, Repatriation of Remains, 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 service not arranged by On Call International will not be considered for payment. For more information, go to gallagherstudent.com/Berklee, and select "My Benefits and Plan Information" in the menu on the left for details on the services offered by On Call International*.
*If you waived the student health insurance plan, this program may be purchased on a voluntary basis. Go to gallagherstudent.com/Berklee and select "Other Insurance Products" from the menu on the left for information on Gallagher Student’s Study Abroad Program.
Dental and Vision Coverage
Berklee's Student Health Insurance Plan does not provide dental or vision coverage. However, students enrolled in the plan have access to discount programs available exclusively from Gallagher Student at no additional cost. These plan enhancements, called Gallagher Student Complements, include the Basix Dental Savings Program, EyeMed Vision Care, and CampusFit.
For more information, select "Dental and Vision Discount Programs" from the links at the left, or go to gallagherstudent.com/Berklee, and select "Discounts & Wellness" in the menu on the left.
Coverage for Dependents
Insured students may also enroll their spouse and/or children under the age of 26 who reside with the student. 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 also add eligible dependent(s) if the student experiences 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 the student experiences one of these qualifying events, the Dependent Enrollment Form, supporting documentation, and payment must be received by Gallagher Student within 31 days of the qualifying event. Forms received more than 31 days after the qualifying event will not be processed. Once a dependent is enrolled, coverage cannot be terminated unless the student loses eligibility.
As of June 26, 2015, the U.S. Supreme Court ruled that the U.S. Constitution grants same-sex couples the right to marry in all states. Therefore, fully insured health plans, in all states, must consider same-sex spouses eligible for the same coverage as spouses of the opposite sex. Since Berklee College of Music's Student Health Insurance Plan includes coverage for a subscriber's spouse in a legal marriage, students may add a same-sex spouse using the regular enrollment process (as outlined above). The same enrollment rules related to marriage as a qualifying event also apply.
(Please note: Blue Cross Blue Shield of MA plans currently do not offer coverage for Domestic Partners, regardless of gender.)
Students may enroll their eligible dependents online for an additional premium by visiting gallagherstudent.com/Berklee, selecting "Dependent Enroll", and completing the form by the appropriate enrollment deadline to add dependents: September 15 (fall), February 15 (spring), and June 15 (summer). For information on additional premium costs (above the student premium) and coverage dates, contact Gallagher Student at 800 391-8057 or email them at Berkleestudent@gallagherstudent.com.
Continuing Coverage after Policy Termination
Students may continue their coverage on a direct-pay basis through Blue Cross Blue Shield after their policy terminates. Go to bluecrossma.com and click on the "Find a Health Plan" box to review and compare plans and products. You can also contact Gallagher Student at gallagherstudent.com/Berklee for other possible plan options.