HMO (Health Maintenance Organization)An HMO is a group of health care providers who provide care through the HMO for a flat rate. Only visits to professionals within the HMO network are covered by the policy. All visits, prescriptions and other care must be cleared by the HMO in order to be covered. A primary care physician within the HMO, selected by the patient, handles referrals. The Brandeis Health Center is not an in-network provider.
PPO (Preferred Provider Organization)
A PPO is a health care organization composed of physicians, hospitals or other providers which provides health care services at a reduced fee. A PPO is similar to an HMO, but care is paid for as it is received instead of in advance in the form of a scheduled fee. PPOs may also offer more flexibility by allowing for visits to out-of-network professionals at a greater expense to the policy holder. Visits within the network require only the payment of a small fee. There is often a deductible for out-of-network expenses and a higher co-payment.
The amount a patient has to pay before the insurance policy will begin to cover for services.
A predetermined, flat fee an individual pays for every prescription and health care visit, in addition to what insurance covers.
Services provided by a health care provider who is a member of the plan’s Preferred Provider Organization (PPO) and HMO.
Out of Network
Services provided by a health care provider who is NOT a member of the plan’s Preferred Provider Organization (PPO) and HMO.
Health Insurance Frequently Asked Questions
What is QSHIP?
Do I have to buy QSHIP? What if I am already covered through my parents or spouse?
What medical expenses does QSHIP cover?
What is the name of the insurance company that provides QSHIP?
The plan we are currently using is Harvard Pilgrim Student Health. The plan is underwritten by HPHC Insurance Company and administered by United Healthcare Student Resources. The broker of the plan is Gallagher Koster Insurance Agency. Their customer service number is 1-800-457-5599. You can access online info about your account at gallagherkoster.com
Can I use the Health Center if I don't have QSHIP?
All undergraduates may use the on campus Health Center and PCC regardless of insurance. Graduate students may elect to pay the Health Center Fee to be seen at the Health Center. If graduate students choose to not pay this fee, there are options for off campus health care, where any insurance may be used. There is never a co-payment or charge for services at the Health Center, regardless of your insurance plan. Off campus services such as labs, urgent care, referrals and pharmaceuticals will be charged to your insurance plan.
I never got a QSHIP insurance card (or I may have lost it). How can I get a replacement?
Visit gallagherkoster.com, and select Brandeis from the drop down menu. Click on Generate Replacement ID card from the left side menu. You must log in to use this page. Once on the Generate Replacement ID Card page loads, click on Authorize Your User Account. Here you will enter your Student ID (Sage ID number), date of birth, and Brandeis. Once the account has been authenticated, click on Generate Replacement ID Card in the left hand menu and click on the checkbox next to Yes! I would like to generate a replacement card! And click on the Generate Card button. A new ID card will print on your printer.
Do I need a referral from the Health Center to see an outside doctor or specialist?
Where can I get a list of doctors who accept QSHIP? Is there a co-payment?
Will QSHIP cover the cost of any lab tests or x-rays? What if I have private insurance?
It is your responsibility to know if the insurance requires you to use a specific lab or testing site for lab tests or x-rays. We try to accommodate all plans used by our students, but cannot be responsible to know which insurance plans have specific requirements. We encourage students and their families to know about the coverage restrictions of their individual plans.
Are my medical records confidential? Do my parents, spouse or partner find out about every visit?
If you have private insurance through a family member, you may want to check with your insurance company, to see if any billing information will go to the primary card holder. If you are over 18 you can call your insurance company to request that billing or explanations of Benefits (EOB) be sent to your personal address.
What should I do if I have a problem with my insurance through the university?
Why do we need Gallagher Koster, Medco, Harvard Pilgrim and UnitedHealthcare StudentResources (UHCSR)?
Harvard Pilgrim Insurance Company is the company that actually insures our program. Because they are the insurance company, your QSHIP ID card will have the Harvard Pilgrim name and logo on it. QSHIP also uses Harvard Pilgrim providers in Massachusetts, Maine and New Hampshire. To locate a participating Harvard Pilgrim provider, please visithttps://www.geoaccess.com/uhc/po/Default.asp
UnitedHealthcare StudentResources is the claims administrator that pays claims for Harvard Pilgrim Insurance Company. The claims address is on the back of your QSHIP ID card. The plan also uses UnitedHealthcare’s PPO network for providers outside of Massachusetts, Maine and New Hampshire so that you’ll have access to participating providers anywhere in the country. To locate a participating UHC provider, please visit https://www.geoaccess.com/uhc/po/Default.asp.
The pharmacy program is administered through UnitedHealthcare, using Medco participating pharmacies. Participating pharmacies include national retail chains such as CVS, Walgreens, Brooks, Rite Aid, as well as local independent pharmacies. For more information, visithttps://www.uhcsr.com/SHIP/PrescriptionDrugPlan.aspx. (Please note that this Web site can only be viewed using Internet Explorer and Safari.)
Can I purchase additional coverage through QSHIP?
The Optional Major Medical Benefit begins payment after the Basic Maximum Benefit of $100,000 has been paid by the Company. The Company will pay 100% for In-Network Providers or 80% for Out-of-Network Providers for additional Covered Medical Expenses incurred up to the Major Medical maximum of $400,000. The total benefit payable under Major Medical is $500,000 minus the Basic Benefits already paid.
For additional information, see the QSHIP brochure.
I signed up for insurance through Brandeis. I didn’t receive a brochure with a detailed explanation of coverage. Where can I get that information?
I’m a graduate student. Where can I go for health care if I do not pay the Health Center fee?
See Emergencies: Urgent Care/Walk-In Centers. The Health Center keeps a list of local physicians and specialists which we can give to you. Just come in and ask at the front desk.
I didn’t go onto Sage to report my private insurance. I ended up with QSHIP by default. What can I do?
I wanted QSHIP and rather than electing to enroll though Sage, I was enrolled by default and had to pay for my prescriptions in September.
I enrolled for QSHIP in Sage on August 17. I went to the pharmacy on August 20 and they told me I wasn’t insured.
For reimbursement information:
- Go to www.medcohealth.com
- Click on the “Forms & Cards” link
- Click on “Request order forms and cards” link
- Enter your Member ID# and Date of Birth
- Download a copy of the Medco reimbursement form or request to have a form mailed to you
For years I used a particular pharmacy. When the university changed insurers I had to pay out of pocket to use this pharmacy. Why did this happen?
I had difficulty getting claims paid. How do I get assistance?
We are happy to help you resolve any problems you may have. Do not hesitate to contact us.
If you have any questions, please call us at 781-736-3677 or contact Diana Baccari email@example.com.