About the Health Plans
MIT offers eligible employees a choice of health plan options, including health maintenance organizations (HMO), a point-of-service (POS) plan and a preferred provider organization (PPO) to assist with most types of medical care. There are no pre-existing condition exclusions under these plans.
Comparing the Plans
MIT offers a Health Plan Comparison Chart (PDF) to help employees understand and compare the features of each type of plan.
Health Maintenance Organizations (HMO)
When you join an HMO, you must use HMO doctors and facilities (except in the case of a life-threatening emergency outside of the HMO service area). You generally pay a small copayment for any care you receive within the HMO network. HMOs provide for most health care needs, including preventive and routine types of care.
HMO plans operate through a network of medical professionals. If you join one of these plans, upon enrollment you must choose a physician from the network of physicians associated with your plan or one of the staff physicians at a designated health center upon enrollment. Your PCP assists with the coordination of your care, provides routine care, and refer you to specialists within the same group of providers, or "network," if needed.
You can change your PCP at anytime by contacting the plan directly. If you require specialty care, your primary care physician will refer you to a specialist who is usually within your PCP's same hospital group.
- Traditional MIT Health Plan - (Group # 2221013)
This Plan provides care through a staff of medical professionals at MIT Medical centers in Cambridge and Lexington, MA. When you enroll, you choose a primary care physician (PCP) on staff at MIT Medical who coordinates your medical care. You may choose a mental health provider from Value Options Network. For more information on the Traditional Heath Plan visit http://web.mit.edu/medical.
- Tufts Health Plan - (Group # 14792-000)
This Exclusive Provider Organization (EPO) is a self-insured version of a managed care plan. Much like a traditional HMO plan, the Tufts Health Plan EPO covers you when care is provided or authorized by a Tufts primary care physician (PCP) you select from a special network of providers determined by Tufts Health Plan. For more information regarding the Tufts Health Plan visit http://www.tuftshealthplan.com.
- Network Blue New England - (Group # 4022818)
This plan coordinates its coverage through medical centers, medical specialty groups and independent practitioners. When choosing a PCP, you may choose providers from HMO Blue New England, HMO Blue, and Blue Choice New England. You may visit the Blue Cross web site at http://www.bcbsma.com
Point of Service Plans (POS)
- Flexible MIT Health Plan - (Group # 2264345)
When you need medical services or supplies, you can either use the health care services available through your "in-network" benefits at the MIT Medical Department and by referrals from your plan physician, or you can arrange your own care under the "out-of-network" benefits by using any provider within the Blue Cross Blue Shield health care provider network. When you arrange your own care, you will pay a portion of the cost over and above your regular premium contribution. You receive reimbursement from the plan after satisfying the annual deductible and copayments. For more information on this plan visit http://web.mit.edu/medical.
Preferred Provider Organization (PPO)
- Blue Care Elect - (Group # 2313307)
This Plan allows members to determine the amount of their benefits each time they obtain a health care service. Participants receive benefits provided under this plan when they use a provider in the Blue Care Elect preferred network. These networks are offered in each state so this plan can be used in Massachusetts or outside the state. These services are called members "in-network benefits" and usually, members will pay nothing or a co-payment of $10 per visit.
When members obtain services from a non-preferred provider, they will usually receive a lower level of cost sharing. This means members' out-of pocket expenses will be more, and members are required to meet an annual deductible and pay a 20% co-insurance payment for allowable charges. These services are called "out-of-network benefits." More information on Blue Cross is available at http://www.bcbsma.com
