Learn more about your health plan options by browsing the FAQs below.
You can also compare the plans using this chart, and read our 2024 Benefits Brochure.
PPO stands for Preferred Provider Organization. PPO is a type of health plan with a network of providers who are "preferred," that is, a member can visit these preferred in-network physicians and does not need to choose a Primary Care Physician (PCP).
The PPO+ Plan and HDHP use the same network called a Preferred Provider Organization (PPO).
No. Provider referrals are not required for either plan.
An authorization is an approval of services/benefits before they are obtained. You will still need prior authorizations for some services.
Yes, if you wish. but you are not required to designate a PCP.
Yes, but you are not required to designate a PCP.
A deductible is the amount you pay for covered medical plan services before the insurance plan starts to pay.
The BCBS PPO+ Plan has the following deductibles: $150/individual and $300/individual + spouse/domestic partner, individual + child(ren), and family. This deductible applies to higher cost services such as inpatient hospital, outpatient surgery, emergency room, and imaging.
The $300 deductible is embedded. This means it can be met by eligible costs incurred by any combination of members enrolled under the same plan, but no one member will have to pay more than the $150 per member deductible. The plan begins to make payments once as soon as one member has reached their individual deductible.
The HDHP has the following deductibles: $1,600/individual and $3,200/individual + spouse/domestic partner, individual + child(ren), and family.
The $3,200 deductible is aggregate. This means it can be met by eligible costs incurred by any combination of members enrolled under the same plan, but an individual member may pay more than the per member deductible. The entire family deductible must be met before the plan pays for services for any one member of the family.
A copayment (copay) is a set dollar amount you pay for each visit, after any applicable deductible is met.
The portion of eligible expenses that plan members are responsible for paying, most often after the deductible is met. Co-insurance is usually determined as a percentage of the total provider's actual charge, or the allowed amount.
This is the maximum payment the plan will pay for covered healthcare services. It sometimes may also be called "eligible expense" or "negotiated rate."
The OOP maximum is the most a member will pay per year for covered services. Both of MIT's health plans have an embedded OOP maximum. This means it can be met by eligible costs incurred by any combination of members enrolled under the same plan, but no one member of the family will have to pay more than the per member OOP.
The OOP maximums for the PPO+ Plan are $2,500 per member and $5,000 per family. The OOP maximums for the HDHP are $3,000 per member and $6,000 per family.
Specialists are providers whose practices are limited to treating a specific disease (e.g., oncologists), specific parts of the body (e.g., ear, nose, and throat), or specific procedures (e.g., oral surgery).
An out-of-network deductible allows employees to seek services outside of the BCBS network, however, deductible and co-insurance apply. The term refers to physicians, hospitals or other healthcare providers who do not participate in an insurer's (BCBS) provider network. This means that the out-of-network provider has not signed a contract agreeing to accept the insurer’s negotiated prices. For example, many mental health providers do not belong to a provider network.
Yes. Surgical services are typically covered for members age 18 and older, but BCBS will review authorizations on a case-by-case basis if the member is under age 18.
The benefits are similar. Any member who meets the age requirement (under age 44) is eligible for the voluntary egg cryopreservation, and any member who is diagnosed with a medical condition that is expected to render them infertile is eligible for the medically-necessary egg cryopreservation benefit. In both cases, the plan covers the egg retrieval, freezing, and storage.
For voluntary egg cryopreservation, members have a $15,000 lifetime maximum for this benefit with no egg storage time limit (storage is covered until you hit the $15,000 maximum). Members who use medically-necessary cryopreservation have no lifetime maximum with a 24-month time limit for egg storage.
This new BCBS program provides Care Managers, Service Advocates, registered dieticians, and Medical Director reviews to address a broad spectrum of healthcare needs and barriers to care. The team can help you navigate the complex healthcare system, coordinate care and access to services, provide education, and find the resources you need in your community.
Virtual Primary Care is an innovative way to do primary care that’s convenient, comprehensive, engaging, and modern. You can now choose a Virtual Primary Care Provider (PCP) at Carbon Health or Firefly Health, BCBS’ virtual primary care partners. Your PCP at Carbon Health or Firefly Health will lead your Virtual Care Team.
There is a $0 copay for virtual primary care and mental health visits offered via chat, text, phone, and video with select providers for BCBS PPO+ members.
BCBS HDHP members will need to meet their deductible first, and then the virtual primary care and mental health visits will have a $0 copay.
To get started with your Virtual Care Team, you will select a virtual Primary Care Provider (PCP). You will also get access to a care coordinator, and your team may include other experts, such as a mental health specialist, based on your needs. Scheduling visits is as easy as hopping online, with appointments available in days, not weeks. Plus, you can reach out to your team with questions via talk, text, email, and chat.
After your first visit, you will receive a welcome kit which may include connected medical devices, like a blood pressure monitor, that make your virtual care as thorough as in-person visits. When you do need in-person care, your team will help find a specialist who works for you and follow up with you after the appointment.