BCBS Summary of Benefits, BCBS benefits, Blue Cross Blue Sheild Benefits

BCBS Summary of Benefits

This page describes the insurance for individual full-time University of Rochester students through Excellus BlueCross BlueShield, Rochester Region (Excellus BCBS). Full-time students are required to participate in this plan unless they complete the online Health Insurance Selection Process indicating they are waiving the insurance plan because they have other insurance. The BCBS Summary of Benefits is available as a Word document and in pdf format.

BCBS Summary of Benefits

BCBS Summary - PDF Format

BCBS Summary - Word Format

Eligibility

Length of Coverage: Coverage is from September 1 through August 31 as long as the student remains a full-time student at the University of Rochester. Students who choose to change their insurance selection during the year can do so by completing the online Health Insurance Selection Process. Students who graduate in May or June are covered until August 31 unless they notify UHS they wish to cancel their coverage before that date. Students graduating mid-year can check with the UHS Insurance Advisor at (585) 275-2637 for information about coverage termination.

Termination of Coverage: Students who cease to be active, full-time students are automatically disenrolled from the insurance plan on the first of the month following receipt of the notification by UHS. See Guaranteed Conversion on this page for information about arranging for continuing coverage through Excellus BCBS.

Insurance for Spouses, Domestic Partners, and Dependents: Students who are enrolled in the BCBS insurance can also enroll their spouse/domestic partner in the BCBS insurance. Specific eligibility guidelines apply for domestic partners. The spouse/domestic partner must pay the mandatory health fee and will receive the benefits covered by that fee in addition to the services covered by BC/BS. The University High Deductible Plan is available for students with dependent children. For more information, check the UHS web site at www.rochester.edu/uhs or contact the UHS Insurance Advisor at insurance@uhs.rochester.edu or (585) 275-2637.

(Note: A domestic partner is a person living with the student as a domestic partner with whom the student cannot legally marry, e.g., partner of the same sex. Check Insurance for Domestic Partners for eligibility guidelines for domestic partners.)

Prior Authorization

This contract requires prior authorization from UHS for certain services. Please pay particular attention to the services requiring a prior referral or approval from UHS (e.g., visits to the emergency room for non-emergency care, referrals to specialists, etc.). The services requiring a prior referral or approval are noted with **NEED PRIOR REFERRAL**. Talk with your primary care provider or the UHS Insurance Advisor if you have questions.

Guaranteed Conversion

Students who are disenrolled from the University's Excellus BlueCross BlueShield, Rochester Region (Excellus BCBS) student insurance have the option of purchasing health insurance coverage directly with Excellus BCBS. Students are notified at the last known address of this option within 90 days of disenrollment. If the student pays the premium included with that notification within 30 days, enrollment in the direct Excellus BCBS contract is automatic without medical review, additional waiting periods, or application procedures. If a student is no longer in the Rochester area, Excellus BCBS will advise the student about procedures for transferring coverage to his/her local BCBS carrier. Benefits and premiums will differ from the University of Rochester student contract. Students should contact BCBS at (585)325-3630.

Coordination of Benefits

When students are covered by two health insurance plans that provide similar benefits, benefit payments will be coordinated with payment made under the other plan. One company will pay its full benefit as the primary plan. The University of Rochester BCBS will pay secondary benefits if necessary to cover all or some of the remaining expenses, preventing duplicate payments and overpayments. Individuals will not be reimbursed for claims in excess of 100% of the expenses incurred.

Payment for Benefits and Services

Most physicians in the area served by the Excellus BCBS have signed a contract to accept allowances in accordance with the Blue Shield Fee Schedule. These physicians are called participating (or in-network) physicians. For Rochester area physicians who do not participate in Blue Shield (i.e., non-participating or out-of-network), the fees are covered up to 50% of the Blue Shield Schedule of Allowances.

If you receive services outside the Excellus BCBS service area, you may find that the physician's charge is higher than is allowed on the BlueCross BlueShield Fee Schedule. For benefits that are covered "up to the rate on the Excellus BCBS or Blue Shield Fee Schedule" this means you are financially responsible for paying the remaining balance.