Frequently Asked Questions

Terms to Know

Question: What is a deductible?
Answer: This is the amount you pay each calendar year before the plan begins paying benefits for services subject to coinsurance.
For the PPO, the plan begins paying benefits for inpatient and outpatient services and diagnostic such as lab tests and imaging a covered person when he or she meets the individual deductible amount. It then pays benefits for all covered family members when the family deductible amount is met by any combination of the remaining covered family members. Prescription drugs and office visit copays are not included in the medical deductible.
For the Health Savings Plan, the plan begins to pay benefits for any individual only when the family deductible has been met. The family deductible may be met by any combination of covered family members.

Question: What is coinsurance?
Answer: Once you meet the annual deductible, you pay a percentage of the total cost of care, and the plan pays a percentage of the total cost of care. The percentage you pay is called your “coinsurance.” Services that count toward the deductible include hospital and outpatient facilities, as well as labs and other tests.

Question: What are copayments (“copays”)?
Answer: A copay is the flat dollar amount you pay for doctor’s office visits, prescription drugs and emergency room visits under the PPO Plan. Copays are not charged for preventive care. Copayments do not count towards satisfying the annual deductible, but they do count towards the annual out-of-pocket maximum, described below.

Question: What is an out-of-pocket maximum?
Answer:  The out-of-pocket maximum limits the amount you pay each calendar year for covered services. Your out-of-pocket maximum includes the deductible, coinsurance and any copays. Once you reach this maximum, the plan covers 100% of the cost of any additional eligible expenses you incur for the rest of the plan year.
For the PPO Plan, there are separate out-of-pocket maximums for medical and prescription drug costs.
In the BU Health Savings Plan, the out-of-pocket maximum is the same for medical and prescription drug costs.

MetLife Vision Plan

Question: Where can I locate my subscriber ID number for the plan?
Answer: If you enroll in the vision plan during open enrollment, your subscriber ID number will be your BUID number, excluding the letter ‘U’.

The Network and Your Doctor

Question: How is a provider defined in the context of these plans?
Answer:  A provider is a physician or medical facility such as a hospital which provides medical care.

Question: Do I need to designate a PCP with the PPO Plan?
Answer:  No. You need not designate a Primary Care Physician when you enroll in either of the health plan options.

Question: How can I find an in-network provider for the PPO Plan?
Answer:  View the list of BCBS National PPO Network providers. Select the PPO or EPO with Hospital Choice Cost Sharing feature to access the network of providers covered under this plan.

Question: How can I find BMC providers at locations other than BMC?
Answer:  View the listing of network providers to find all of the BMC physicians and their locations.

Question: How do I figure out which hospitals are low-cost and which are high-cost?
Answer: View the list of high-cost hospitals. If not listed, the hospital is considered low-cost.

Question: If I am eligible for BU’s contribution to a Health Care FSA, do I need to take action to receive the contribution?
Answer: No. You do not need to be enrolled in the Health Care Flexible Spending Account.  BU will make a contribution to the plan without you taking any action. Be sure to take advantage of using this contribution for any eligible out of pocket expenses. In addition, you may want to consider making your own contributions to the FSA to take advantage of the tax savings on your out-of-pocket healthcare costs.

Question: If I choose BMC physicians, does this mean that the University can access my medical records?
Answer: No. Your medical records are kept in strict confidence. Your information is protected by the Health Insurance Portability and Affordability Act of 1996 (HIPAA).

Coverage Levels

Question: Will all four coverage levels continue to be available?
Answer:  Yes. You have the choice of Employee Only; Employee plus Child(ren); Employee plus Spouse; and, Family Coverage.