Covered Services
Routine Physicals
Routine physical exams are covered according to the following schedule:
For children:
- Six visits per year (0–12 months)
- Three visits per year (12–24 months)
- One visit per year (2–18 years)
For adults:
One physical exam is covered each calendar year. Includes an annual mental health wellness exam
Waiver of Deductible and Coinsurance:
Routine physicals are covered 100% with no deductible or coinsurance for in-network care.
Out-of-network preventive care is covered 70% with no deductible.
Mental Health Wellness Exam
Beginning on March 31, 2024, Blue Cross will cover an annual mental health wellness exam. This exam may be conducted as part of the annual preventive visit with a primary care provider (PCP), or as a standalone visit with a PCP or licensed mental health professional. Because the mental health wellness exam is considered preventive care, there is no out-of-pocket cost for members in most plans.
The annual mental health exam is covered as required by the Act Addressing Barriers to Care (ABC Act) to improve mental health care across Massachusetts.
The exam will consist of taking the patient’s mental health history, a mental health exam and appropriate screening tests, shared decision making (that could include lifestyle education and counseling), and a discussion about next steps. This may include referrals for treatments and medication options. The mental health wellness exam may or may not result in a diagnosis. The exam may be administered by a PCP, including OB/GYNs, licensed mental health professional as part of the annual wellness visit or as a separate exam.
Emergency Coverage
The BU Health Savings Plan provides benefits for emergency medical services whether you are in or outside of Massachusetts. These emergency medical services may include inpatient or outpatient services by providers qualified to furnish emergency medical care and that are needed to evaluate or stabilize your emergency medical condition.
In an emergency, such as a suspected heart attack, stroke, or poisoning, you should go directly to the nearest medical facility or call 911 (or the local emergency phone number). After your deductible, you pay 12% coinsurance for in-network or out-of-network emergency room services.
Home Health Care Benefits
The BU Health Savings Plan pays benefits for medically necessary home care services and supplies, such as intermittent skilled nursing care and physical therapy, at 88% (after the deductible) when you use a participating provider, and at 70% (after the deductible) when you use an out-of-network provider.
Coverage is also provided for the following services when determined to be a medically necessary component of the intermittent skilled nursing care or physical therapy:
- Occupational therapy
- Speech therapy
- Medical social work
- Nutritional consultation
- Home health aide
- Durable medical equipment
Prescription Drug Benefits
As a member of the Boston University Health Plan, you will automatically be enrolled in the OptumRx Prescription Drug Coverage. After you meet your annual health plan in-network deductible, you will pay 12% coinsurance for all covered prescription drugs.
Learn more about your prescription drug coverage.
Mental Health and Substance Abuse Benefits
The BU Health Savings Plan will pay benefits for inpatient and outpatient treatment of mental health and substance abuse.
| Mental Health and Substance Abuse Benefits | ||
|---|---|---|
| Mental Health | In-Network | Out-of-Network |
| Inpatient admissions to a licensed general hospital | Covered at 88% after deductible | Covered at 70% after deductible |
| Inpatient admissions to a mental health facility | Covered at 88% after deductible | Covered at 70% after deductible |
| Outpatient services | Covered at 88% after deductible | Covered at 70% after deductible |
| Substance Abuse | ||
| Inpatient admissions | Covered at 88% after deductible | Covered at 70% after deductible |
| Outpatient services | Covered at 88% after deductible | Covered at 70% after deductible |
| Detoxification for drug/alcoholism | Covered at 88% after deductible | Covered at 70% after deductible |