2025-2026 Benefits at a Glance
Student wellness is essential to academic progress at Baylor College of Medicine. To support this philosophy, Baylor maintains the Student Health Insurance Plan. Baylor requires that all individuals enrolled in any Baylor academic program elect coverage through Student Health Insurance Plan or choose to waive coverage if they have an individual policy that meets all of the Baylor waiver criteria.
Blue Cross and Blue Shield of Texas (BCBSTX) is the insurance vendor for the 2025-2026 academic year. Additionally, we will continue to partner with Academic HealthPlans (AHP) to provide enhanced customer service to assist students. When logging on to the AHP website students will see ‘AcademicBlue’, AcademicBlue refers to the student health insurance plans provided by BCBSTX.
Medical Plan Overview
Knowing how your medical plan works can make navigating healthcare decisions easier and save on out of pocket costs. It’s important to know the details such as the cost difference when going in or out of network, the copayment, the coinsurance and annual out of pocket maximum, etc. Review the 2025-2026 Medical Plan Design and Benefits Summary to become more familiar with the details of your plan.
Frequently Asked Questions
Premiums are based on the utilization rate of the group and BCM renegotiates the coverage annually to find the best option that meets the requirements for coverage at the best cost for the student.
Students are asked to waive coverage every year, even if previously waived, to ensure they are always covered even if their circumstances change. Additionally, policies, plans, etc. can undergo changes, so it is best for all that the matter is addressed yearly, even if it can feel a bit tedious. Read through the Waiving the Student Health Insurance section for this year’s waiver criteria. The criteria that is set for students that wish to waive the SHIP is based on the ACA guidelines. Our office uses this as an annual gauge to ensure that all students, if enrolled or waived, have a similar, if not uniform level of coverage.
Students are required to contact the Student Benefits office at ask-studentinsurance@bcm.edu or (713) 798-1500 (option 7) to enroll into the SHIP. The Student Benefits office will also contact the student as a reminder that action must be taken due to their turning 26. To avoid delays, students are encouraged to contact the Student Benefits office prior to loss of coverage to complete an enrollment form and provide documentation that coverage will be ending or has ended. (Note that coverage is pro-rated monthly, not daily.)
Visit https://bcm.myahpcare.com/ to find a pharmacy or doctor in your network.
The Student Health Insurance Plan (SHIP) offers an annual eye exam to all enrolled students and or dependents. This benefit is provided under the medical benefit.
Glasses, contacts and other vision services continue to be offered at a discounted rate through Blue365. View additional details on EyeMed Vision Care, Davis Vision as well as other great discounts.
Effective 7/1/2024, students have the option to purchase an individual vision plan through Blue Cross Blue Shield of Texas. Please visit the AHP site for more details.
If you have other questions about your health insurance plan, visit https://bcm.myahpcare.com/benefits. The Benefits Office includes important announcements in the Student Commons newsletter on a monthly basis; it is strongly encouraged that students read this email each week.
| Coverage Level | Monthly Premium (Includes Medical and Dental) |
|---|---|
| Student | $522.00 |
| Student & Spouse/Domestic Partner | $1,044.00 |
| Student & One Child | $1,022.00 |
| Student & Two or More Children | $1,522.00 |
| Student & Spouse/Domestic Partner & One Child | $1,544.00 |
| Student & Spouse/Domestic Partner & Two or More Children | $2,044.00 |
Virtual Visits
If you are currently enrolled in the Student Health Insurance Plan, you have access to care around the clock. By downloading the MDLIVE app, you will have access to a live consultation with an MDLIVE doctor for many non-emergency medical needs 24 hours a day, 7 days a week for various health conditions such as allergies, asthma, cold/flu, and nausea.
With a virtual visit appointment, you can also speak with a licensed counselor, therapist or psychiatrist for any behavioral health needs. You can choose who you want to work with for issues such as anxiety, depression, trauma, and loss or relationship problems.
MDLIVE allows you access to care in the comfort of your own home, right at your fingertips. The cost of this service is a $10 copay when seeing a Network provider and 70 percent of the Allowable amount when choosing an Out of Network Provider.
For more details and instructions on how to schedule a virtual visit view the Member Flier or the Interactive Brochure.
Prescription Drug Program
Your BCBSTX offers a prescription drug program through Prime Therapeutics to make it convenient for you to fill your prescriptions. Most major chain drug stores are included in the national pharmacy network. It’s likely that your local pharmacy participates in the network. Your prescription may be subject to prior authorization and step therapy.
Save with Generic Drugs
Your prescription may be filled with a generic drug. A generic drug contains the same active ingredients in the same amount as the corresponding brand-name drug. The Food and Drug Administration (FDA) requires that generic drugs meet the same strict manufacturing standards for strength, purity and quality as brand-name drugs. Ask your doctor to allow a substitution, if appropriate, whenever you get a prescription. If your doctor has prescribed a brand-name drug, ask your pharmacist whether there is a generic equivalent.
| Type | At pharmacies contracting with Prime Therapeutics Network |
Prescriptions dispensed from an Out-of-Network pharmacy |
|---|---|---|
| Generic | 100% after $10 copay | 70% after $10 copay |
| Preferred Brand Name | $40 copay | 70% after $40 copay |
| Non-Preferred Brand Name | $60 copay | 70% after $60 copay |
| Mail Order (90 day supply) | Generic: $30 copay Preferred Brand Name: $120 copay Non-preferred Brand Name: $180 copay | Not applicable |
Contraceptives now covered at 100% except for Brand drugs with Generic equivalent.
Rx Pre-Certification is now required for certain drugs.
*Copay plus the cost difference between the brand-name drug or supplies per prescription for which there is a generic drug or supply available.
Dental Plan Overview
The Blue Care Dental is included with your medical plan. Under the BlueCare Dental plan, you may visit any licensed dentist. However, you will generally save when you visit a participating provider. Search dentists online.
Vision Coverage and Discount Program
If you are covered by the Student Health Insurance Plan you are eligible to receive an annual eye exam. The annual eye exam is covered under the medical benefit and is the student's responsibility to seek services from a participating provider for this service. Vision discounts are also available and the benefit is provided through Blue365. The vision discount is provided to help you with the out-of-pocket costs on eye exams, prescription eyeglasses and disposable contact lenses and more. This discount also applies to dependents covered on your health plan. When visiting a participating provider bring your BCBSTX medical id card to receive the vision discount. Learn more about how the vision discount works.
All students have the opportunity to purchase an individual vision care policy directly through the provider, Blue Cross Blue Shield of Texas. The purchase of this plan is open to all students and you do not need to be enrolled into the SHIP to participate. Note that your enrollment and premium charges for this vision plan are the responsibility of you as the student. The HR Student Benefits office does not manage or administer this plan. View more information on Enhanced Products.
Wellness
We believe your wellness is essential to your academic success. Students that participate in the Student Health Insurance Plan have access to discounts on gym memberships and other wellness programs. Read more about available resources.
Note: These programs are only available to students enrolled in the Student Health Insurance Plan.
Waiving the Student Health Insurance
Students may apply to waive participation in the Student Health Insurance Plan (SHIP) if the student has alternate coverage that meets all of the criteria listed below. Students MUST apply for a waiver of coverage each academic year. Once your waiver is submitted, your alternate coverage will be verified to ensure it meets all the BCM waiver criteria. The waiver criteria for the 2025-2026 academic year are:
- In-network coverage in the Houston area 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).
- Plan does not provide emergency-only coverage.
- Plan meets minimum value standard of 60%, meaning that it has at least bronze medal status under the Affordable Care Act and is ACA compliant. Short Term Medical and Grandfathered ACA plans may not meet these criteria.
- In-network individual annual out-of-pocket maximum of $9,200 or less.
- Coverage for prescription drugs (prescription discount cards will not be accepted as coverage)
If you become ineligible or lose your alternate coverage, you must enroll in the SHIP upon loss of your alternate coverage or obtain a new alternate policy that meets the above-mentioned criteria. If another alternate policy is obtained, it is the responsibility of the student to submit a new waiver that includes the new policy information.
Leave of Absence (LOA)
Students currently enrolled in the Student Health Insurance Plan prior to their first day of an approved Leave Absence (LOA) have the option to continue health insurance for a maximum of 12 months following the last day of the month in which their LOA is effective. Students have 31 days from their effective date of LOA to checkout with the HR - Student Benefits office and elect to continue health insurance by completing the Student Continuation for Insurance while on Leave of Absence form and submit a check for the first month of leave. This form can be obtained by contacting the Student Benefits HR office.
Payment of Premiums while on Leave of Absence
The Student Continuation of Insurance while on Leave of Absence form outlines the payment process, how to submit payment, where to submit payment, termination of coverage details, and additional medical coverage information. Payment can be made via credit by logging into your CAMS student portal. The online system accepts VISA, MASTERCARD and DISCOVER. A mandatory convenience fee of 3% will apply to each online transaction. You may also remit payment in person or by mail, in the form of a personal check, money order or cashier’s check. Your initial payment must be received or be postmarked by the due date assigned by our office. Each payment after must be received no later than the 1st of the month in which you are paying. Students are encouraged to utilize the online payment system. Payment made to the Baylor HR - Student Benefits office is for individual coverage only. Dependent payments will continue to be billed by Academic HealthPlans (AHP) through your personal bank account or credit card.
Late Payment, No Payment and Termination of Coverage
Coverage will be terminated effective the 1st of the month in which payment is late, not received, or when the student has reached the maximum 12 months of coverage. In the event that a student submits a late or no payment, then a one time grace period will be extended. The student will have seven calendar days from the last day of the month in which payment is late or not received to submit a check to the HR - Student Benefits office for the total amount of premiums owed for the remainder of their approved leave period. For example, if a payment was due on April 1 then the student would have until May 7 to submit payment as a one time grace period. Payment must be made (postmarked) on or before the 7th day of the grace period. To calculate premiums owed refer to the table below:
| Academic Year | Monthly Premium | Coverage Level |
|---|---|---|
| 2025-2026 (July 1, 2024 - June 30, 2025) | $522.00 | Student only |
Student premiums are subject to change on July 1 of each year. Students are encouraged to contact the Human Resources – Benefits office if they should have any questions.
Student premiums are subject to change on July 1 of each year. Students are encouraged to contact the HR - Student Benefits office if they should have any questions.
Health Insurance Billing
Billing for the Student Health Program is charged to the student’s tuition bill and administered through the Student Account Services Office. For questions in regards to health charges or due credits contact their office directly at (713) 798-4322 or sas@bcm.edu.
Billing for dependent coverage is administered directly through AHP. For questions in regards to dependent health charges contact their customer service representatives directly (855) 856-4117 or go to https://bcm.myahpcare.com.