Medical Coverage
As a benefits eligible Brandeis University employee, you have access to comprehensive medical coverage to protect you and your family from catastrophic medical costs. The University offers four Medical Plan options from which you can choose. All plans use a network of doctors, hospitals and other health care providers to deliver high quality care.
- Enrollment
- Changes
- Coverage End
- COBRA Continuation
- Harvard Pilgrim Health Care (HPHC) – Administrator of the plans when you use service. Provide detail specifics of coverage. What, covered what’s not. Provides charges for services.
- HPHC/Brandeis Microsite - find Benefit Summary's, Statement of Benefits, Provider Directories and more.
- MyConnect- (866-623-0184) Member Advocate HPHC Member Service team. A Point32Health program provided at no cost to Brandeis through edHealth.
- Behavioral Health Information
- Doctor On Demand
- Healthy You wellbeing program
- Secure Member Account & Mobile Access(pdf) pdf.spanish
- Decision Doc - an interactive tool to help guide you in making decisions about medical care
- OptumRx – Pharmacy Benefit Administrator
- Terminology Definitions
- HDHP - HSA keypoints
- Retiring
- Medicare
- Benefit FAQ's
Plan Types
Visit the HPHC-Brandeis Microsite for Details About Each Plan
HMO with Deductible
BestBuy HMO includes in-network coverage only. You must choose a primary care physician (PCP) and receive referrals to specialists in the HPHC network. PCP and specialist office visits are covered with copays and in-network services are covered 100%. A deductible applies to non-routine services, labs and diagnostic testing. In patient stays and day surgery have higher co-pays and must meet the deductible ($500 per individual/$1,000 per family) .
HMOHMO Plan includes in-network coverage only. You must choose a primary care physician (PCP) and receive referrals to specialists. PCP and specialist office visits are covered with copays and in-network services are covered 100%.
High Deductible Health Plan with HSA
- BestBuy HMO HSA includes in-network coverage only. You must choose a primary care physician (PCP) and receive referrals to specialists within the HPHC network. The deductible of $1,600 for an individual and $3,200 for a family applies to all both medical and pharmacy services. The family deductible is an aggregate and not capped individually
PPO Plan
- The PPO Plan offers a nationwide network of healthcare providers through United Health Care (UHC) to choose from and your cost varies based on your use of that network. You are not required to choose a PCP for your care.
- If you choose a provider within the HPHC network for covered services, you pay an office visit copayment. If you choose an out-of-network provider, you pay coinsurance for covered services after you meet the plan’s deductible. There is both an individual and a family deductible for out-of-network care under this plan. You always have the choice to go to any provider, but you’ll pay less if you use a HPHC network doctor or hospital.
NOTE: Employees who reside outside of Massachusetts and who do not live within the HMO service area (New Hampshire, Maine Rhode Island, Vermont and some parts of Connecticut) are not eligible to enroll in the HMO Plans. Your option for medical insurance coverage is the PPO Plan.
edHealth
Group of Higher Ed and Secondary schools that pooled together to purchase health insurance and related health insurance and risk management products. Creates a larger claim pool which reduces costs and helps smaller schools to be able to offer affordable insurance for members.
Negotiates with the HPHC for the different versions of plan options; 2 or 3 types of PPO’s HMO’s HDHP’s for Brandeis to choose from to offer their employees. Also negotiates the annual overall rates for each employer based on claims experience, high claimant stop-loss coverage and general overall trend for the year.
- edHealth contracts with OptumRx to provide the pharmacy benefits.
Point32Health
Point32Health – Parent company of the merger between two primary health plan companies in MA. Now one well being company but still maintains the two plans which have different customer bases. HPHC is for commercial customers (like Brandeis). Tufts is for government related customers like MassHealth and Medicare. Negotiates contracts with Physicians and physician networks to provide in-network coverage for members.