Student Health Insurance
How can I remove the health insurance charge?
The Commonwealth of Massachusetts mandates that all students enrolling in nine (9) or more credit hours must be covered by health insurance. If you have other coverage you must complete the waiver form on line at www.kosterweb.com. If you do not complete the waiver form on line, you must be billed for health insurance. If the waiver is completed after the due date, we will not be able to reverse the billing for the health insurance.
Student Health Insurance Brochure
This document is only a summary of the benefits available. Please refer to the actual Student Accident and Sickness Insurance Plan brochure for a description of the benefits available and exclusions and limitations of the plan.
Who do I contact if I have questions or need help?
Questions about enrollment, benefits, ID cards, how the plan works?
Koster Insurance Agency
500 Victory Road, Quincy, MA 02169
800-457-5599
Email: Studentcare@kosterins.com
Questions about a specific claim or claims payment?
Pioneer Management Systems, Inc.
330 Whitney Avenue
Holyoke, MA 01040
877-868-9060
Email: Student@pioneerhealth.com
How can I find a Preferred Provider?
Health Care Value Management (HCVM) (throughout New England)
800-922-4286
www.hcvm.com
How can I find an Express Scripts pharmacy?
www.ExpressScripts.com
Who can enroll?
All regular full-time and ¾ time students
What is covered under the Student Accident and Sickness Insurance Plan?
The plan covers medical expenses, including hospital room and board, inpatient and outpatient surgical procedures, emergency outpatient care, lab and x-rays, mental health, prescription drugs and physician office visits.
- Coverage varies depending on whether or not you seek services from a Network or Non-Network Provider
- Coverage is subject to the limitations and provisions of the policy.
Can I go to any doctor or hospital?
Yes. However you can save money from seeing providers that participate in the Pioneer Health or the Health Care Value Management Preferred Provider Network.
Your out-of-pocket expenses will be less because preferred providers are reimbursed at 90% of the preferred allowance; non-preferred providers are reimbursed at 70% of usual and customary charges.
Preferred Allowance is a preferred negotiated fee that providers have agreed to accept as payment. Providers who are not a preferred provider, have not agreed to accept a preferred fee as their payment;
You should be aware that preferred hospitals might be staffed with non-network doctors, so it’s not a guarantee that all charges will be paid at the preferred allowance;
Take the time to ask the doctors you want to see if they participate in on of the preferred provider networks.
What if I have a Pre-Existing Condition, am I covered?
Yes, if you were previously covered under another health insurance plan immediately prior to enrolling in the Student Accident and Sickness Insurance Plan for at least six (6) months without a lapse in coverage of more than 30 days, any pre-existing condition will be covered. If you were not enrolled in another health insurance plan or had a lapse in coverage of more than 30 days, you will not be covered for any pre-existing condition until you’ve been enrolled under the Student Accident and Sickness Insurance Plan for six (6) months. After you’ve been enrolled for 6 months, your pre-existing condition will be covered as any other condition.
Do I get an ID Card?
You will receive an insurance ID Card at the address you provided on the enrollment card. Carry it at all times and show it to the doctor or any other healthcare provider before receiving care or filling a prescription.
If you need to see a doctor before you receive your ID card, tell the provider that you are covered under the Merrimack College student insurance program. Your provider can always call Koster Insurance at 800-457-5599 to verify eligibility. If you need an ID card, request one by email to: Studentcare@kosterins.com
If I receive a bill for services I received, what should I do?
Physicians should bill the claims administrator directly. If you receive a bill, you should also forward it to the claims administrator at the address below. You do not need a claim form. Make sure your name, ID number, and school name are on the bill, make a copy for your records, and send it to the claims administrator.
Pioneer Management Systems, Inc.
330 Whitney Avenue
Holyoke, MA 01400
E-mail: student@pioneerhealth.com
How are prescription drugs covered?
- $10 for a 30-day supply of a generic drug and $25 for a 30-day supply of a brand name drug
- Per policy year maximum of $500 per policy year.
- Use an Express Scripts participating pharmacy; CVS, Walgreens, Brooks, and local pharmacies.
Does this plan cover me when I am off campus?
Yes, the Student Accident and Sickness Plan covers you during semester breaks, summer vacation and even if you’re studying abroad. You’ll be covered for the period for which you paid premium. So if you bought coverage for the entire year, you would be covered from August 13, 2008 through August 13, 2009.
Does this plan cover routine eye exam or the cost of eyewear?
The Student Accident and Sickness Insurance Plan doesn’t cover these vision services, but if you are enrolled in the insurance plan, you also get enrolled in the EyeMed Vision Program.
EyeMed’s plan includes discounts on prescription eyeglasses, contact lenses or even non-prescription sunglasses. Some of the nation’s most highly qualified laser vision correction surgeons will even offer savings.
What about Dental Coverage?
Koster has an exclusive Dental Savings Plan. Students enrolled in the student insurance program can use The Dental Savings Program to save up to 50% on dental care. You need to make an appointment with one of the preferred dental providers and pay at the time of your visit in order to take advantage of these savings. To locate a participating dentist in your area and to get a copy of the fee schedule, go to http://www.basixstudent.com and select your college from the drop-down box.
Are there any other insurance plans available to me?
Optional Supplemental Accident and Sickness Insurance Plan
Students enrolled in the Student Accident and Sickness Insurance Plan have the option of purchasing additional coverage through the Optional Supplemental Accident and Sickness Expense Benefit. This plan does not start providing coverage until the $25,000 maximum per Accident and Sickness per policy year has been met under the Student Accident and Sickness Insurance Plan, and extends the Maximum benefit per Accident and Sickness to $50,000. Interested students must purchase this optional benefit by August 13, 2008 for annual coverage or January 15, 2009 for newly enrolled students for the spring semester.
Emergency Medical Evacuation, Repatriation of Remains and Travel Assistance
These plans are available to international students or students participating in a Merrimack College Study Abroad Program. Under Emergency Medical Evacuation, coverage is provided if students are hospitalized for five (5) days or more, upon the recommendation and approval of the attending Physician, for their medical evacuation back home or to a facility operated pursuant to the law for the care and treatment of injured or ill persons. The plan covers the actual Expense incurred, but not to exceed $10,000 in the aggregate and is payable in addition to any other benefit of this policy. These services must be approved in advanced by the travel assistance company.
Repatriation of Remains provides coverage if a student dies while insured under this policy. The actual expenses incurred for preparation and transportation of the student’s body to his or home country (in accordance with the applicable international requirements) the remains of the deceased’s body, but not to exceed $10,000 in the aggregate. This benefit is payable in addition to any other benefit of this policy. These services must be approved in advanced by the travel assistance company.
Assistance Services
In addition to the insurance benefits described above, the plan includes access to a worldwide assistance network. In the event that an Insured student needs help with a medical situation, Insured students will be able to call (toll-free) the assistance center which is staffed 24 hours a day by professional multi-lingual assistance specialists. These specialists can provide help in locating appropriate medical care; assistance in establishing contact with family members or friends, personal Physician and/or educational institution; Emergency message transmittal; arrangements and transportation costs for a family member or friend to travel to the Insured student’s bedside in the event of hospitalization for more than 7 consecutive days; arrangement and coordination of a medical evacuation or repatriation; referral to legal assistance if necessary; and assistance with other types of medical and travel emergencies.