You will receive the most cost-effective level of benefits (known as in-network benefits) if you (and those you cover) designate a Primary Care Provider. The MIT Choice Plan also provides an “out-of-network” benefit for family members who live outside of the HMO Blue New England Network, or for those who choose to receive care outside of the network.
Individuals who want to access only the "out-of-network" benefit (for example, a permanent resident of Maryland or Florida) do not have to select a PCP, but those who want to receive the "in-network" level of coverage must select a PCP.
MIT Choice allows families to split their primary care relationships between MIT Medical and primary care providers in the HMO Blue New England network. The MIT Choice Plan offers flexibility if MIT Medical is not convenient for all family members. If you do not select a PCP, regardless of whether you currently reside within the Blue Cross New England network, your benefits will be paid as "out-of network" and will be subject to a deductible and coinsurance as indicated below.
Under the "out of network," benefit, members will pay for all visits to health professionals until they meet the $500 deductible, per individual; $1,000 per family. After meeting the $500 individual or $1,000 family deductible, you will also be responsible to pay 25% of any medical bills for services received by a Blue Cross Blue Shield provider until the annual out-of-pocket dollar amount is reached. This is called co-insurance. The annual out-of-pocket amounts for services received by a Blue Cross Blue Shield provider are $2,500 per individual or $5,000 per family. The $500/$1000 deductible amounts are included in these annual out-of-pocket amounts.
What You Should Know
- When you select the MIT Choice Plan, each family member covered under your health plan will be charged a co-pay for health care visits based on the location of his or her primary care provider (PCP).
- You will be charged a $10 copayment for each visit to an MIT Medical healthcare provider or if you receive a referral from an MIT Medical provider if you select an MIT Medical PCP.
- You will pay a $20 copayment for each visit to a provider in the HMO Blue New England Network if you select a PCP from the HMO Blue New England (Blue Cross Blue Shield) network.
- You can avoid the $50 copayment for high-tech imaging such as a CT scan, MRI, or PET, at Shields MRI with a referral from your PCP. If you visit any other provider for these tests, you will be required to pay the $50 high-tech imaging copay.
- You must get a referral from your PCP for visits to most network health care providers.
- Learn how to choose or change your PCP.
- Review the MIT Choice Plan Summary of Benefits (available below).
MIT Choice members will use two ID cards: one for healthcare services (from Blue Cross Blue Shield) and one from Express Scripts for pharmacy benefits.
Remember, you need to present your new health plan ID card the first time you visit any health care provider.