2019-2020 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 2019-2020 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 2019-2020 Medical Plan Design and Benefits Summary to become more familiar with the details of your plan.
Monthly Premium (Includes Medical and Dental)
Student & Spouse/Domestic Partner
Student & One Child
Student & Two or More Children
Student & Spouse/Domestic Partner & One Child
Student & Spouse/Domestic Partner & Two or More Children
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.
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.
At pharmacies contracting with Prime Therapeutics Network
Prescriptions dispensed from an Out-of-Network pharmacy
100% after $10 copay
70% after $10
Preferred Brand Name
70% after $40
Non-Preferred Brand Name
70% after $60
Mail Order (90 day supply)
Generic: $30 copay
Preferred Brand Name: $120 copay
Non-preferred Brand Name: $180 copay
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.
Vision Discount Program
If you are covered under the Student Health Insurance Plan then you are eligible to participate in the vision discount benefit provided through the benefit provided through Blue365. The vision discount does not provide vision insurance but is a discount provided to help you with the out of pocket costs on eye exams, prescription eyeglasses, 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.
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.
Please 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 2019-2020 academic year are:
- Plan provides in-network coverage 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
- In-network individual annual out-of-pocket maximum of $7,900 or less
- 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.
- Plan provides 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 –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.
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 may be made by check, money order or cashiers check. Payment must be made (postmarked) on or before the 1st of each month for that month’s coverage. Students are encouraged to mail payments via certified mail to ensure proof of payment. If you are covering dependents payment will continue to be billed by 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 Human Resources – 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:
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.
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 please contact their office directly at 713-798-4322 or email@example.com.
Billing for dependent coverage is administered directly through AHP. For questions in regards to dependent health charges please contact their customer service representatives directly 855.856.4117 or go to https://bcm.myahpcare.com.