Office of Human Resources

Brandeis University prides itself on offering faculty and staff comprehensive and competitive benefits, including medical, dental, and pharmacy benefits.

Eligible faculty, staff, and dependents can choose from four medical options administered through Harvard Pilgrim Health Care, with the university contributing an average of 66% and up to 87% of the annual premium. Further, each year Brandeis spends roughly $20M on medical and prescription claims based on the current self-insured design of these programs.

Brandeis helps control our long-term healthcare costs in several ways:

• We are part of edHEALTH, a collaboration of 28 educational institutions working together to save schools money on healthcare services. The advantages to being part of edHEALTH include the power in numbers when negotiating with our health plan and the personal MyConnect customer service you receive from Harvard Pilgrim Health Care.
• Our medical plan is funded via a self-insured structure, which means that Brandeis pays the medical claims up to a certain amount. If a claim exceeds the predetermined cost level, we have the protection of stop-loss insurance, which provides coverage for all expenses above this amount. The self-insured design is a more economical option than a fully insured arrangement, where Brandeis would pay a fixed premium to a third-party insurance carrier for medical claims and administrative expenses.

Despite our best efforts, and as you may have seen in the news, healthcare costs continue to increase year after year, both locally and at the national level. Some of the reasons for these increased costs include:

• Inflation: Increased costs for hospital and provider wages, medical supplies, and technology are passed on to consumers and insurers.
• High-cost prescription drugs: The development and demand for expensive specialty medications, including newer drugs for obesity and diabetes (GLP-1s), are significant cost drivers.
• High utilization: Many people are now catching up on medical care they delayed during the COVID-19 pandemic. An aging workforce with an increased need for medical care also drives costs.
• Market consolidation: A trend of consolidation among hospitals, physician practices, and insurance companies has resulted in larger health systems with greater negotiating power, leading to higher prices for services. Massachusetts offers some of the best healthcare in the United States, which can also lead to higher costs than other parts of the United States.
• New technology and procedures: Ongoing medical advancements, such as new cell and gene therapies, lead to more expensive treatments and products. It is important to acknowledge that advances in medicine and pharmaceuticals, such as new specialty medications and GLP-1s for weight loss, and a pronounced increase in our high-cost medical claims, have significantly driven up our healthcare costs over the past few years.

Brandeis helps control our healthcare costs by being part of edHEALTH, a collaboration of 28 educational institutions working together to save schools money on healthcare services. Brandeis has been a member-owner of edHEALTH since 2015.

While edHEALTH often stays in the background for our faculty and staff, our Human Resources and Finance staff work very closely to ensure you have comprehensive medical and pharmacy coverage. Some of the many advantages to being part of edHEALTH include:

• Power in numbers when negotiating with our health plan, e.g., the personal MyConnect customer service you receive from Harvard Pilgrim Health Care.
• Partnering with our pharmacy provider, OptumRx, to offer our faculty and staff prescription drug programs.

Looking ahead to 2026, Brandeis, and most other organizations, are facing extraordinary challenges with increasing health care costs.

Brandeis' Human Resources and Finance teams, along with edHealth, are actively working with other edHEALTH schools, Harvard Pilgrim Health Care, and Optum Rx to find solutions to these challenges. Faculty and staff, we need your help too!

Learn more about how to help us reduce health care risks and costs.

• Taking control of your health. Stop smoking, get enough sleep, exercise, and eat right—small daily choices can have a big impact on your health.
• Stay up to date on vaccinations, screenings, and annual checkups. Early detection and preventative care are the best ways to avoid poor health outcomes and large medical bills.
• Go to the right provider at the right time: Take advantage of your primary care provider or Doctor’s On Demand for same-day sick visits. Use the emergency room for emergencies.
• Open and use your Health Savings Account (HSA)/ Flexible Spending Account (FSA) to pay for medical expenses, supplies, and other eligible services.
• Take advantage of reimbursement from HPHC.
• Be an active consumer when filling your prescriptions: download your OptumRx prescription discount card, explore home delivery options/order online, and use drug coupons with Optum Perks.

• Co-insurance: The percentage of each bill you must pay out-of-pocket.
• Co-payment: The fixed amount of each bill you must pay out-of-pocket. The co-pay is usually due at the time of service.
• Coordination of Benefits (COB): When two or more insurance plans cover the same person, Coordination of Benefits is used to determine which plan pays first.
• Covered Benefits: The health care items or services covered under a health insurance plan. Covered benefits and excluded services are defined in the health insurance plan's coverage documents.
• Deductible: The amount you pay for covered health care services before your insurance plan starts to pay. With a $300 deductible, for example, you pay the first $300 of covered services yourself. The deductible may not apply to all services. Typically, health plans will have a separate deductible for in-network vs. out-of-network providers.
• Durable Medical Equipment: Equipment and supplies ordered by a health care provider for everyday or extended use. Coverage for DME may include: medically-necessary splints, wheelchairs, crutches or blood testing strips for diabetics.
• Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
• Network: The facilities, providers, and suppliers your health insurer or plan has contracted with to provide health care services. Networks change, so it’s important to check with your health plan to be sure your provider(s) are in-network at the time you receive care.
• In-Network: The provider or facility has a contract with the insurance company and has negotiated a contracted or discounted rate with the insurance. You generally pay less when you receive care from an in-network provider.
• Out-of-Network: The provider or facility does not have a contract with the insurance company. You generally pay more when you receive care from an out-of-network provider.
• Non-Covered Benefits or Exclusions: Health care services that your health insurance or plan doesn’t pay for or cover.
• Common exclusions: Travel vaccines and services, massage therapy, cosmetic procedures, non-medically necessary services or supplies, etc.
• Medically Necessary: Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.
• Out-of-pocket maximum: The most you will pay for covered medical expenses during the plan year. Once the out-of-pocket limit has been met, the plan will pay 100% of covered charges for the rest of that plan year. This limit never includes your premium, balance-billed charges, or health care your health insurance or plan does not cover.
• Preauthorization or Prior Authorization (PA): A decision by your health insurer or plan that a health care service, treatment plan, prescription drug, or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval, or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn’t a promise your health insurance or plan will cover the cost. Note: Prior authorization is not required during medical emergencies.
• Preferred Provider Organization (PPO): A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost.
• Premium: The amount you pay for your health insurance coverage. When shopping for a plan, keep in mind that the plan with the lowest monthly premium may not be the best match for you. If you need a lot of health care, a plan with a slightly higher premium but a lower deductible may save you a lot of money.
• Referral: A written order from your primary care doctor for you to see a specialist or get certain medical services. In many Health Maintenance Organizations (HMOs), you need to get a referral before you can get medical care from anyone except your primary care doctor. If you don’t get a referral first, the plan may not pay for the services.
• Subscriber: The name of the policyholder of the insurance plan. In a family plan, this is typically a parent.

Your ID card is key to accessing medical and behavioral health care. Be sure to show your ID card to your primary provider, specialists, and local pharmacy. Understanding Your Insurance Card Flyer.

• Harvard Pilgrim Health Care: Oversees your overall health plan. Whom to call with benefit and network-related questions, and who processes your medical and behavioral health claims. 
• Optum Rx: Your pharmacy benefits managers. Assistance with prescriptions you pick up at your local pharmacy, autorefill, home delivery of routine medications, and, if needed, specialty medications
• edHEALTH: The group of educational institutions that we are part of so we can better control rising costs and improve your overall health benefits experience.
• Doctor On Demand: Offers virtual urgent care and behavioral health care telemedicine visits. Available through your Harvard Pilgrim coverage.

Brandeis University’s Human Resources and Finance departments work together to bring you the best health plan options and experience possible while also controlling costs. We are here to answer your questions.

For benefits-related inquiries, please contact 781-736-4474, Bernstein-Marcus, 2nd floor, MS 118, or the Human Resources Benefits Team at benefits@brandeis.edu.