Fitchburg State University
STUDENT HEALTH INSURANCE PLAN

The waiver and enrollment deadline date for new and incoming students for the Fall 2024 term is October 31, 2024.

In accordance with Massachusetts State Law, Fitchburg State University requires all undergraduate students registered in at least 9 credits and all graduate students registered in at least 4.5 credits to participate in the Student Health Insurance Plan unless proof of comparable coverage is provided. All International students are required to enroll in the Student Health Insurance Plan. Students enrolled in online classes only are not eligible to purchase the Student Health Insurance Plan.

Students with coverage from insurance carriers outside the United States or coverage by foreign National Health Insurance programs may not waive participation in the university’s plan. These plans are not deemed to be comparable to coverage under a QSHIP program. This is a change in the QSHIP regulations that has been mandated by the Division of Health Care Finance and Policy and all institutions are required to comply with this change.

Students must either:

• Complete the On-Line Enrollment Form.
• Complete the On-Line Waiver Form.

New and returning students for the Fall 2024 Semester who fail to complete the on-line enrollment or waiver form will have a hold placed on their student account and will not be able to continue academic advancement until they complete an on-line enrollment or waiver form. As provided by Massachusetts State Law, completion of the on-line enrollment or waiver form is required annually. Health Safety Net is not considered comparable coverage.

Please allow 7-10 business days from the date of your waiver submission for the credit to be reflected on your student bill.

Cost and Coverage Periods

Annual Students

New Spring Students

Waiver/Enrollment Deadline

October 31, 2024

April 30, 2025

In order to waive coverage, be sure that services covered by your current health insurance plan are reasonably accessible in the Fitchburg area:

• Lab tests and x-rays
• Prescription drugs
• Outpatient hospital services
• Mental health care
• Emergency room care
• Hospitalization (including room and board, physician’s fees, and surgical expenses)

To complete the Enrollment Form or Waiver Form, select appropriately from the MENU options to the left. When you have completed and successfully submitted the form, you will immediately receive a notice indicating the completion of the form. Please print this notice for your records. If you provide an email address on your form you will also receive an email confirmation.

Please note, if you do not complete a waiver form or enrollment form by the posted deadline date, you will be automatically enrolled in and charged for the Annual Term of the 2024/2025 Student Health Insurance Plan. As stated above, this is Massachusetts State Law.

Please contact University Health Plans at 1-833-251-1724 if you have any questions.

• Introduction
• Contact Information
• BCBSMA COVID-19 Updates
• FAQs

Student Health Plan

• Waiver Form
• Enrollment Form

Benefit Information

• 24-25 Summary of Benefits and Coverage
• 24-25 Plan Highlights
• 23-24 Summary of Benefits and Coverage
• 23-24 Plan Highlights
• Subscriber Certificate (Policy)
• Pediatric Dental (Policy) for members under 19

Blue Cross Blue Shield Info

• Member Central
• Healthy Times
• 24-Hour Nurseline
• Glossary of Insurance Terms
• Estimate Medical Costs
• Blue 365
• Fitness Benefit
• Weight Loss Benefit
• Mental Health Resource Center

Prescription Info

• Medication Look Up
• Prescription Claim Form

Optional Plans

• Massachusetts Delta Dental Plans
• VSP Vision Care Plan
• Renters Insurance
• Dorm Insurance

Additional Information

• Health Connector Participant Info
• Insurance Info for Graduating Students and Dependents

Please note, with the rising costs of healthcare, and increase in utilization of the Plan, the following plan changes have been imposed for the 2024-2025 academic year to help keep the insurance premium and the plan a viable option for all students.

• Deductible will be $500
• Out-of-pocket maximum will be $9,100
• In-network preventive care - deductible will not apply.
• In-network office visit copay will be $30 for primary and mental health visits and $65 for specialist visits (deductible will not apply in-network).
• Emergency room copay will be $200 (deductible will not apply).
• Ambulance services - new deductible will not apply.
• Diagnostic Tests & X-rays - In-network copays will be $50 for lab and $100 for x-ray (deductible does not apply). Out-of-network will be a 20% coinsurance.
• Imaging (CT/PET scans, MRIs will be a 20% coinsurance in-network/40% coinsurance out-of-network
• The 5-Tier Plan prescription drug copays: deductible does not apply
  • Tier 1: $20 copay (generic)
  • Tier 2: $40 copay (preferred brand)
  • Tier 3: $60 copay (non-preferred brand)
  • Tier 4: 50% coinsurance (preferred specialty)
  • Tier 5: 50% coinsurance (non-preferred specialty)

  To look-up your prescription medication in the 5-Tier Plan, choose Prescription Info → Medication Look Up in the navigation menu on the left.

  We encourage students anticipating high out-of-pocket costs to compare other insurance options to the SHIP. The Massachusetts Health Connector offers information about their online insurance marketplace where you can compare and purchase insurance plans. You may be eligible for a Subsidized Health Plan (a low or no cost insurance program for qualifying uninsured adults).

  Please note, with the rising costs of healthcare, and increase in utilization of the Plan, the following plan changes have been imposed for the 2024-2025 academic year to help keep the insurance premium and the plan a viable option for all students.

  • Deductible will be $500
  • Out-of-pocket maximum will be $9,100
  • In-network preventive care - deductible will not apply.
  • In-network office visit copay will be $30 for primary and mental health visits and $65 for specialist visits (deductible will not apply in-network).
  • Emergency room copay will be $200 (deductible will not apply).
  • Ambulance services - new deductible will not apply.
  • Diagnostic Tests & X-rays - In-network copays will be $50 for lab and $100 for x-ray (deductible does not apply). Out-of-network will be a 20% coinsurance.
  • Imaging (CT/PET scans, MRIs will be a 20% coinsurance in-network/40% coinsurance out-of-network
  • The 5-Tier Plan prescription drug copays: deductible does not apply
    • Tier 1: $20 copay (generic)
    • Tier 2: $40 copay (preferred brand)
    • Tier 3: $60 copay (non-preferred brand)
    • Tier 4: 50% coinsurance (preferred specialty)
    • Tier 5: 50% coinsurance (non-preferred specialty)

    To look-up your prescription medication in the 5-Tier Plan, choose Prescription Info → Medication Look Up in the navigation menu on the left.

    We encourage students anticipating high out-of-pocket costs to compare other insurance options to the SHIP. The Massachusetts Health Connector offers information about their online insurance marketplace where you can compare and purchase insurance plans. You may be eligible for a Subsidized Health Plan (a low or no cost insurance program for qualifying uninsured adults).

    Please note, with the rising costs of healthcare, and increase in utilization of the Plan, the following plan changes have been imposed for the 2024-2025 academic year to help keep the insurance premium and the plan a viable option for all students.

    • Deductible will be $500
    • Out-of-pocket maximum will be $9,100
    • In-network preventive care - deductible will not apply.
    • In-network office visit copay will be $30 for primary and mental health visits and $65 for specialist visits (deductible will not apply in-network).
    • Emergency room copay will be $200 (deductible will not apply).
    • Ambulance services - new deductible will not apply.
    • Diagnostic Tests & X-rays - In-network copays will be $50 for lab and $100 for x-ray (deductible does not apply). Out-of-network will be a 20% coinsurance.
    • Imaging (CT/PET scans, MRIs will be a 20% coinsurance in-network/40% coinsurance out-of-network
    • The 5-Tier Plan prescription drug copays: deductible does not apply
      • Tier 1: $20 copay (generic)
      • Tier 2: $40 copay (preferred brand)
      • Tier 3: $60 copay (non-preferred brand)
      • Tier 4: 50% coinsurance (preferred specialty)
      • Tier 5: 50% coinsurance (non-preferred specialty)

      To look-up your prescription medication in the 5-Tier Plan, choose Prescription Info → Medication Look Up in the navigation menu on the left.

      We encourage students anticipating high out-of-pocket costs to compare other insurance options to the SHIP. The Massachusetts Health Connector offers information about their online insurance marketplace where you can compare and purchase insurance plans. You may be eligible for a Subsidized Health Plan (a low or no cost insurance program for qualifying uninsured adults).

      Contact Information

      For waiver, enrollment, eligibility, general benefit questions or plan issues
      contact University Health Plans at 833-251-1724.

      For specific benefit or claims questions
      contact Blue Cross Blue Shield of Massachusetts at 888-753-6615.

      University Health Plans Broker License # 000123936000
      William E. Devine Broker License # 34773

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