BCM Healthcare Program for Students Frequently Asked Questions

Vendor Changes for 2018/2019 Academic Year

1) Q: Who will be the vendor for the BCM student health plan?
A: Blue Cross and Blue Shield of Texas (BCBSTX) will be the new insurance vendor for the
2018/2019 academic year. Additionally, we will partner with Academic Health Plans
(AHP) to provide enhanced customer service to assist you.

2) Q: How do I know what providers will be covered under the BCBSTX network?
A: To find in-network providers visit www.bcbstx.com click on Find a Doctor or Hospital >
Search as Guest > Select Texas > Start Search > Select the Blue Choice PPO from the drop
down menu

3) Q: Why is there a change in vendor for the 2018/2019 academic year?

A: The initial review with the current vendor, Aetna Student Health, offered a 38 percent
premium increase due to unusually high claims experience and high utilization of the
plan. The benefits team worked diligently to reach out to five other vendors, and
successfully negotiated a 4.37 percent increase with a new vendor, Blue Cross and Blue
Shield of Texas (BCBSTX).

4) Q: Will my plan design change with the new vendor?

A: With the new vendor, the plan design which includes deductibles, coinsurance and
copays will remain the same with the exception of the prescription drug and dental
programs.

5) Q: How will the prescription drug program change?

A: The Value Plus Formulary will be implemented to the prescription drug program. This
will help with managing your prescriptions in the following ways:
 Step Therapy– Many brand drugs have less-expensive generic or brand
alternatives that might be an option for you. In some cases this directs
members to another proven, cost-effective medication when they are
available.
 Formulary Exclusions – Prescription drugs on this list will not be covered as
there is a current alternative, equal and cost effective drug available.
 Tier Adjustments – Realignment of certain generic and cost-effective
prescription drugs.

6) Q: Where can I find the prescription formulary list?

A: Go to www.bcbstx.com > View Prescription Drug Plan Details > select ‘see if your drug
is covered’ under Prescription Drug List > select ‘Prescription Drug Lists for Employer-
offered Plans: Large Group (51 or more)
7) Q: When is the coverage effective for the 2018/2019 academic year?
A: Elections made during the Annual Student Insurance Change period in May will be
effective July 1, 2018.

8) Q: Who is Academic Health Plans (AHP) and how will they assist?
A: AHP is a student health insurance administrator that will assist with enrolling/waiving,
ways to find doctors, facilities and other services to best meet your healthcare needs.

9) Q: How can I get in contact with AHP?

A: AHP can be reached at 855-856-4117, Monday-Friday 8:30 a.m. - 4:30 p.m.

10) Q: Am I able to enroll for just the medical coverage and not dental?
A: No, the dental plan is not a voluntary plan but is embedded in the medical plan and
therefore it is not possible to choose one plan and not the other.

11) Q: What will be the Student Health Plan monthly premiums for the 2018/2019 academic
year?
A:

Monthly Premium
Coverage Level
(Includes Medical and Dental)

Student Only/International Visitor Only $ 440.25

*Spouse/Domestic Partner Only $ 440.25

*One Child $ 420.58

*2 or More Children $ 841.17

*Spouse/Domestic Partner and One

$ 860.83
Child

*Spouse/Domestic Partner and Two or

$1,281.42
More Children

* Note that these premiums are in addition to the student premium.

12) Q: What will be the criteria to waive coverage in the BCM student health plan?
A: The criteria to waive coverage will change for the 2018/2019 academic year. To
waive coverage in the BCM student health plan, you must have and maintain alternative
coverage that meets the criteria below:
a. Plan provides in-network coverage in the greater Houston metropolitan area
(unless you are a Distance Education Student, then your plan must provide in-
network coverage in the area in which you reside).
b. Plan does not provide emergency-only coverage
c. Individual annual out-of-pocket maximum of $7,350 or less
d. Plan meets minimum value standard of 60 percent or more
e. Plan provides coverage for prescription drugs (prescription discount cards will
not be accepted as coverage)
The overall goal when setting waiver criteria is to ensure that all students have access to
adequate health coverage if they should be sick or injured. The waiver updates are
aligned with Affordable Care Act (ACA) limits such as outpatient, ER, hospitalization,
mental health and substance abuse, rehabilitation, preventive and wellness services.

13) Q: Who should I contact with any additional questions?

A: Please direct any questions about your healthcare benefits to
713-798-1500 or ask-studentinsurance@bcm.edu