highmark ppo blue benefits booklet 2021
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Highmark ppo blue benefits booklet 2021

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If you already use Nelnet Campus Commerce to pay your tuition and fees, you can add your health insurance premiums to that plan. For details or to enroll in a health insurance payment plan, visit www. The monthly payment option is only available during Fall Open Enrollment.

By default, the medical CMU SHIP premium fee is posted on student accounts; the fee is reversed for students who apply for and receive an approved waiver during open enrollment. Students who do not submit an enrollment or receive an approved waiver before the end of their open enrollment period are enrolled in the student medical plan. Waiver applications are only accepted during Open Enrollment. Waiver applications submitted before the end of Open Enrollment will be processed as on-time waivers.

If approved, the student insurance charge will be removed from the account; if a waiver is not approved because the plan does not meet university requirements , the student will be enrolled in the student medical insurance plan.

With an approved waiver, the student is accepting full financial liability for any medical costs incurred. Choose the option I intend to waive, answer all questions and provide the required documentation. How-to Video. Documentation required for waiver applications. From there, update your personal information in the Student Information section or add a dependent in the Submit Enrollment section.

Please allow a several business days for processing. If you're enrolling a dependent outside of Open Enrollment, HUB International the company processing CMU student insurance enrollments will reach out to you to request documentation i. Please note that you have 30 days from the qualifying event date to add your dependent to your plan. Cancellations of the medical SHIP are only permitted in certain circumstances. Eligible students should email us at shinsure andrew.

Students who cancel may be eligible to receive a pro-rated refund for the remaining months' premiums. Cancellations will only be accepted before March 31, The option to join a new plan does not make a student eligible to cancel their current insurance enrollment.

Student dental and vision plans cannot be cancelled outside of Open Enrollment. Approved medical SHIP cancellations are always effective on the first day of a month. For example:. Student Health Insurance Plans Highmark Blue Cross Blue Shield will be our student health insurance provider; plans are available for Carnegie Mellon University undergraduate and graduate students and their eligible dependents.

How to enroll or waive get answers to common student insurance Questions This video shares helpful information about health insurance options at CMU. Spring Open Enrollment December 19, - January 31, This open enrollment period is for new students, for insurance coverage January 1 - July 31, Highmark Updates Highmark rebate checks will be mailed to students who were enrolled in and paid the premium for the SHIP.

About the Highmark Student Insurance Plans. How to use Amwell virtual medicine [pdf]. The open enrollment period for medical insurance corresponds with a student's first active semester on campus each academic year. Each year, students must either enroll in CMU SHIP medical or apply to waive it if they have insurance that meets university requirements during their open enrollment period.

This is an annual requirement. Beginning December 19, , new spring semester students can fulfill this requirement by:. Enrollment for vision and dental plans is only available during fall and spring open enrollment. Both timeframes are open to all eligible participants.

Nelnet Campus Commerce allows you to pay your insurance premium in nine monthly payments September through May. If you already use Nelnet Campus Commerce to pay your tuition and fees, you can add your health insurance premiums to that plan. For details or to enroll in a health insurance payment plan, visit www. The monthly payment option is only available during Fall Open Enrollment. By default, the medical CMU SHIP premium fee is posted on student accounts; the fee is reversed for students who apply for and receive an approved waiver during open enrollment.

Students who do not submit an enrollment or receive an approved waiver before the end of their open enrollment period are enrolled in the student medical plan. Waiver applications are only accepted during Open Enrollment. Waiver applications submitted before the end of Open Enrollment will be processed as on-time waivers. If approved, the student insurance charge will be removed from the account; if a waiver is not approved because the plan does not meet university requirements , the student will be enrolled in the student medical insurance plan.

With an approved waiver, the student is accepting full financial liability for any medical costs incurred. Choose the option I intend to waive, answer all questions and provide the required documentation. How-to Video. Documentation required for waiver applications. From there, update your personal information in the Student Information section or add a dependent in the Submit Enrollment section.

Please allow a several business days for processing. If you're enrolling a dependent outside of Open Enrollment, HUB International the company processing CMU student insurance enrollments will reach out to you to request documentation i. Please note that you have 30 days from the qualifying event date to add your dependent to your plan. Cancellations of the medical SHIP are only permitted in certain circumstances.

Eligible students should email us at shinsure andrew. Students who cancel may be eligible to receive a pro-rated refund for the remaining months' premiums. Cancellations will only be accepted before March 31, The option to join a new plan does not make a student eligible to cancel their current insurance enrollment.

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Pharmacy Benefits for Managed Care Members Highmark administers prescription benefits for almost all members. For those members, the MedcoHealth logo appears on the member's ID card.

Some direct pay benefit plans are not available in every region. All FreedomBlue coverage includes at least the same services as those provided by Medicare. Most prescription drugs are covered when provided or authorized by the PCP on an outpatient basis and obtained at a Premier contracting pharmacy.

The member must still pay applicable copayments. Mandatory Generic Feature Many plans include a mandatory generic provision, which requires that if the generic drug exists but the member or physician specifically requests the brand name drug, the member will have to pay the brand name copayment and the cost difference between the brand name drug and the generic drug. For some plans with a mandatory generic provision, if a member requests the brand name drug, but the prescription does not specify "brand medically necessary," the member will be required to pay the difference in cost between the brand drug and the generic drug, in addition to the applicable brand name copayment.

Coverage for Some Over-the-Counter Drugs Some over-the-counter medications are available through the closed formulary. A prescription is required for these drugs and the member must obtain the medication through the pharmacy for coverage to apply. The member is charged the generic copayment. Premier Pharmacy Networks The prescription drug program offers a wide network of pharmacies and various pharmacy networks, including most national chains and many local, independent pharmacies. Members receive a directory of pharmacies with their enrollment materials.

Pharmacies have point-of-sale technology that confirms a member's eligibility, benefit design and copayment information at the time of dispensing. Managed care members must use one of the participating pharmacies in Highmark's Premier Pharmacy networks. Members may consult their pharmacy directory, visit Highmark's web site at www.

This committee is comprised of network physicians and pharmacists who select products on the basis of their safety, efficacy, quality and cost to the plan. The formulary is designed to assist in maintaining the quality of patient care and containing cost for the patient's drug benefit plan.

Products are removed from the formulary twice a year, January 1st and July 1st, after a minimum of 30 days notification is given to providers. To obtain a copy of the formulary, contact your Provider Relations representative. Highmark's Medical and Pharmacy Affairs department monitors provider-specific formulary prescribing and communicates with providers to encourage use of formulary products.

The drug formulary is divided into sections based on the member's plan benefit design. For members with a Highmark Select or Highmark Choice formulary benefit, non-formulary drugs are not covered under a Select formulary benefit or will require a higher co-payment under a Choice formulary benefit.

The drug formulary is then divided into major therapeutic categories for easy use. Products that are approved for more than one therapeutic indication may be included in more than one category. Drugs are listed by brand and generic names. Most dosage forms and strengths of a drug are included in the formulary. Home delivery service is an option that groups may select depending on their benefit design. Quick Links: Manuals. Highmark Provider Manual. Medical Policy Medical Policy.

Medical Policies. Medicare Advantage Medical Policies. Requiring Authorization. Pharmacy Policy Search. Message Center. Manuals Highmark Provider Manual.

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The many benefits that come with Highmark plans - BS - Member

WebOct 2,  · Some members of SelectBlue and PPO Blue may have other prescription drug coverage that is not administered by Highmark. formulary is designed to assist in maintaining the quality of patient care and containing cost for the patient's drug benefit plan. The Highmark P&T Committee approves revisions to the drug formulary on a quarterly . benefit administration is provided by or through First Priority Health, Highmark Benefits Group, or Highmark Blue Cross Blue Shield, all of which are independent licensees of the Blue Cross Blue Shield Association. Health care plans are subject to the terms of the benefit agreement. Highmark Inc. is an independent licensee of the Blue Cross and Blue Shield Association. Blues On Call is a service mark of the Blue Cross and Blue Shield Association. Jan 1,  · independent Blue Cross Blue Shield Plans across the country and allows providers to submit claims for processing and reimbursement so you don’t have to. However, certain .