Insurance Definitions
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.
Deductible
The amount a patient has to pay before the insurance policy will begin to cover for services.
Copayment
A predetermined, flat fee an individual pays for every prescription and health care visit, in addition to what insurance covers.
In Network
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?
QSHIP stands for a Qualifying Student Health Insurance Plan. Each year the university offers an insurance plan that is in accordance with Massachusetts State Law and Brandeis University additional coverage. The plan is an accident and illness plan with coverage for medications. From time to time, the insurance company may change (for a policy year) as we try to maintain low premiums.
Do I have to buy QSHIP? What if I am already covered through my parents or spouse?
You do not need to purchase QSHIP if you are already covered by a qualifying insurance plan. You will need to submit proof of coverage, by entering your insurance information into Sage. You will also need to send us a copy of the front and back of your insurance card. International plans are acceptable only if they have been purchased through a US based carrier company, regardless of the claims address location.
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?
No referrals are needed with QSHIP, although at times a doctor's office may request one. When you are referred, we will ask you to complete a form which will allow that doctor's office to send us information about your visit. If you have private insurance, we cannot provide insurance referrals though we can suggest providers in the area. For many types of insurance policies, a valid referral must come from your primary care doctor's office, or by calling your insurance company directly.
Where can I get a list of doctors who accept QSHIP? Is there a co-payment?
You can find a list of preferred providers for Harvard Pilgrim or UnitedHealthcare at https://www.geoaccess.com/uhc/po/Default.asp. Physicians can be looked up by location and by specialty. The co-pay is $20 per visit.
Will QSHIP cover the cost of any lab tests or x-rays? What if I have private insurance?
Most lab tests ordered by a provider at the Health Center or by an outside specialist will be covered by your insurance plan. Some optional screening tests may not be covered. There are limits of coverage based on each accident or illness incurred. At times, students who have serious illnesses may reach or exceed those limits.
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?
Medical records are confidential. We cannot release any information to parents or others without your consent. If you are over 18, you are considered an adult, and your records are protected by federal law. If you want us to speak with your parents, spouse or partner, you will need to give us consent each time you come in.
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.
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?
If you have a problem with your insurance or don’t understand a bill you’ve received, please contact Diana Baccari, our insurance coordinator, at baccari@brandeis.edu. PLEASE DO NOT DELAY as claims resolutions sometimes have time constraints. You can also contact Gallagher Koster directly at brandeistudent@kosterins.com or 617-769-6011 or 800-397-1837.
Why do we need Gallagher Koster, Medco, Harvard Pilgrim and UnitedHealthcare StudentResources (UHCSR)?
Insurance programs encompass many components – an insurance carrier, claims company, pharmacy program and provider network. Our QSHIP is no different. Gallagher Koster is our insurance broker/account manager and works with the university to build a program to best meet the needs of the university and our students. The university has had a long, successful relationship with Gallagher Koster. When we can’t resolve issues or have policy questions, we turn to them for assistance and advocacy.
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.)
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?
Students may purchase an Optional Major Medical Benefit; dependents are not eligible to purchase this coverage. This benefit is subject to payment of an additional premium. The cost for students is $537.
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.
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?
Download the QSHIP brochure for information about coverage, exclusions and limitations. If you would like a hard copy of the brochure, contact Diana Baccari at baccari@brandeis.edu.
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?
Each year, students need to make their insurance selection through Sage. The site becomes available in April with a deadline of June 30. Because you didn’t report your private insurance through Sage by this deadline, you are defaulted to QSHIP by Massachusetts State Law. If you are now unable to report your insurance through Sage call the Health Center Insurance Coordinator at 781-736-3681.
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.
If you default, your name is held in a file until late September. You were insured as of August 15. You would be required to pay out of pocket until the insurer receives our last file with your information. This could be as late as mid October. This is why we do not recommend defaulting into the insurance. When your insurance is processed you can complete a reimbursement form. See the next question for reimbursement information.
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.
When you select/report through Sage, your information is held in a file and sent to Gallagher Koster once a week. You can be reimbursed when you receive your ID card.
For reimbursement information:
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?
Unfortunately, not all insurers contract with all pharmacies. We would be happy to help you find a pharmacy in the area that accepts our insurance. You can locate participating pharmacies atwww.uhcsr.com, then click on “Student Health Insurance and Plans” and create an account. (Please note that www.uhcsr.com can only be viewed using Internet Explorer and Safari.)
I had difficulty getting claims paid. How do I get assistance?
Your QSHIP ID card states “Student Health Plan” and has the name and address of the claims administrator on the back of the cared. However, do make sure that your provider knows that you’re enrolled in the student health insurance plan underwritten by Harvard Pilgrim. There was some confusion this past year with providers not recognizing that QSHIP is a student health insurance plan and not one of Harvard Pilgrim's many other health plans. In these cases, claims were not initially sent to the correct claims administrator. Changes have been made to the insurance card and we hope this will avoid any further confusion. Nevertheless, it’s important to point out to your doctor’s office which Harvard Pilgrim plan you have.
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 atbaccari@brandeis.edu.
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 atbaccari@brandeis.edu.