Health Services Fee, Eligiblity & Insurance

Your Health Services Fee

An annual fee ($345 per semester for Academic Year 13-14) is charged to all degree candidates to cover the costs of providing care at Health Services.

Each student is entitled to professional visits to:

  • The primary care staff of physicians, physician assistants, nurse practitioners and nursing.
  • Dermatology care at Health Services - however charges for skin biopsies and lab work are not covered;
  • Health Education - individual visits, outreach programs and visits to the Nutritionist;
  • Up to seven visits to the counseling staff at Psychological Services. This team of clinical psychologists, social workers, and psychiatric consultants provides evaluation, short-term psychotherapy, and crisis intervention;
  • Brown Medical Services (EMS)

Charges are assessed for lab tests, x-rays, prescription medications, birth control, over-the counter drugs, durable medical equipment (crutches, canes, braces, etc.), allergy injections, EKGs and vaccines. The fee does not cover the cost of services and drugs purchased outside Health Services, nor does it include health insurance.

Health Insurance

You are required to have health insurance either purchased through Brown or through your parent(s), guardian, self or partner. This insurance may pay for lab tests, x-rays, hospitalization or medical care that is not covered by the Health Fee. Please be aware of what your individual policy covers.

For more information contact Brown Office of Insurance &Purchasing.

Health Services Fee Waiver

Waivers of the Health Services fee are available only to students who meet one of the following requirements:

  • students who have been given specific permission to enroll in absentia (students not in geographic residence);
  • non-degree candidates other than guest students from other institutions;
  • University regular employees; special students; faculty; and faculty/staff spouses with tuition benefits.

All other students are required to pay this fee.

Undergraduate Waivers

All waivers must be requested in writing. Undergraduates should submit waiver requests to Jennifer Hodshon, Health Services, Box 1928. Semester I requests must be submitted no later than October 15; Semester II requests must be submitted no later than February 15. If a waiver is granted, Health Services credits the student account. Waived students who access services will be charged the full semester Health Services fee.

Graduate Waivers

All waivers must be requested in writing. Graduate students should write to Brian Walton , Associate Dean, Finance and Administration, Graduate School , Box 1867. Semester I requests must be submitted no later than October 15; Semester II requests must be submitted no later than February 15. If a waiver is granted, Health Services credits the student account. Students registered in absentia as traveling scholars are not required to pay this fee. Waived students who access Health Services will be charged the full semester health services fee.

Medical School Waivers

All waivers must be requested in writing. Medical students should email the Records and Registration Office at AMS-Student-Records@brown/edu. Semester I requests must be submitted no later than October 15; Semester II requests must be submitted no later than February 15. If a waiver is granted, Health Services credits the student account. Waived students who access Health Services will be charged the full semester health services fee.

Questions?

For questions regarding your Pharmacy charges, please contact Paul Bergeron at (401) 863-7882

For questions regarding X-ray charges, please contact Donna Rossi at (401) 863-7782

For questions regarding laboratory charges, please contact Lifespan Laboratories Billing Department at (401) 444-6966.

For all other questions related to the fee or other Health Services charges, please contact Jennifer Hodshon at (401) 863-7880.

Insurance

The following general information is designed to help you understand your health insurance.

You may have health insurance other than the Brown sponsered plan (i.e., Blue Cross, Aetna, Cigna, Kaiser, etc.). If so, you will need to find out about specific coverage from your insurance company. We require that you bring with you to campus a copy of your insurance plan and card for reference. Most charges for laboratory testing can be billed directly to your insurance company. For x-rays, the cost of the x-ray will be billed to your student account and you may seek possible reimbursement from the insurance carrier. Coverage by private insurance companies varies greatly-we strongly recommend that you check directly with your insurance company regarding if and how x-ray and lab charges may be covered.

If you are not already covered under a health insurance plan (through parents, guardian, self or partner), you are required to purchase the student health insurance policy (SHIP) offered through the University. This insurance is a separate cost in addition to the Health Services Fee. The Brown sponsored insurance policy is designed with Health Services as your primary place for health care.

Questions about the University sponsored plan should be directed to the Insurance Office (863-1703). A brochure with a more complete description of the insurance plan is available from the Insurance Office. Questions can also be directed to University Health Plans (plan administrator) at 1-800-437-6448.

Most costs other than x-ray, lab and pharmacy offered at Health Services are covered by your Health Services Fee. It is the responsibility of the patient to make sure that adequate information (i.e. insurance card) is available for Health Services to bill properly.

For any additional information you may contact Jennifer Hodshon, at Brown Health Services, 863-7880 or Cheryl Moan, Insurance Specialist, at the student Insurance Office in the Brown Office Building on the 4th floor, 863-1703.

Crash Course in Health Insurance

Gone are the days when students could take care of their health knowing nothing about health insurance and payment. Today, students need to be familiar with the general concepts of health insurance and with the type of insurance they have. While health insurance may seem somewhat confusing to you (at best) or incomprehensible (at worst), with a little help and a little effort you can become adept at interpreting and using your health insurance.

Every Brown student is required...

  • to pay the Health Services Fee (for primary care), and
  • to have health insurance to cover additional health care expenses. Some students buy the health insurance plan offered through the University. Students who are already covered under an insurance plan (owned by the student, a parent or a spouse) may waive the University-sponsored insurance plan but not the Health Services Fee.

Health Services Fee FAQ's:

Why have insurance?

In general, health insurance protects you and your family against major medical expenses. Paying a fixed annual amount (premium) to an insurance company guarantees full or partial payment (coverage) for medical expenses incurred by you or your family. The details of your policy will tell you the type of services that are covered, any special exclusions or restrictions, and what part of the cost you will have to pay(1).

Be prepared when you come to Brown

Know who your health insurance company is and have your insurance card with you every time you seek health care. Carry your insurance ID cards as well as your student ID card. If you are covered by the University-sponsored plans, you will be sent an insurance card. If you are covered by another plan, call the company to get your own card. It is also a good idea to have a copy of your insurance policy with you on campus so you can refer to it when needed.

Be sure to give Health Services your most up-to-date health insurance information. Health Services is your primary provider; we are not your health insurance company. A student may be insured under the plan Brown sponsors or may be insured under a parental or personal plan (e.g., Blue Cross/Blue Shield of Michigan, SelectCare, Harvard Pilgrim Health Plan, Kaiser-Permanente, Nebraska Group Health).

Paying the bills

As the patient, you are responsible for paying costs that are not covered by the Health Services Fee. You may bill these costs to your insurance company, to be paid according to the details of your policy. Bills can be sent to the student on campus; you must arrange this at the time the services are provided (e.g., when blood is drawn) not later. Remember to request that bills be sent to your box on campus, if that is what you want.

Additionally, Health Services accepts cash, checks, VISA, Mastercard, Discover and charges can be billed to the student bursar account.

Confidentiality

Insurance companies may send to the policy subscriber periodic summary statements of payments made. If a parent is the subscriber, and you are concerned about parental notification about your health care, you need to know if your insurance company sends statements of payment, to whom the statements are sent, and how services are described in the statement; call your insurance company to find out. If you ask the insurance company to pay the bills, the subscriber may receive a summary of payments made, even if you have the bill sent to you on campus; ask your insurance company. One way to maintain control of all information related to your health care is to pay the cost without asking the insurance to cover part or all of the cost.

Prescriptions

Most prescriptions at Health Services cost less than at a local pharmacy. Your cost for a specific prescription may change throughout the year as we pay different prices to get the medication. Many insurance policies have a prescription co-payment-- the patient pays part, the insurance pays part. If you have the University plan, please have your insurance ID card with you when you come to the Pharmacy. This plan has a co-pay for generic and brand-name prescriptions -- you pay the copay, the insurance pays the rest. Many of the prescriptions you purchase at Health Services may be less than the copay. If you have insurance other than the University plan, you may need to pay the full cost of the prescription at the time of purchase and then submit a claim to your insurance company to request reimbursement. Your insurance may or may not pay for prescriptions. Check your policy. Some insurance companies require you to purchase your prescriptions at specific pharmacies (participating pharmacies). Find out ahead of time if your policy has such restrictions, and confirm with the specific pharmacy when your order your prescription that they participate in your insurance plan.

Lab tests

Most lab tests (e.g., Pap smear, urine culture, blood work, skin biopsy) are not covered by the Health Services Fee. Lab samples may be collected at Health Services and forwarded to an independent lab with whom we contract for laboratory services. You may be billed for these tests directly or may choose to submit the bill to your insurance company according to the terms of your policy. Again, a student needs to make certain where the bill will be sent, arranging at the time the service is provided to have the bill sent to their campus address if desired.

X-Rays

Many x-rays can be provided at Health Services; some x-rays are not available on site but can be arranged at a radiology facility in the Providence community. Health Services or the radiology group will bill you or your insurance; check your policy for terms of payment for x-rays.

Insurance terminology you need to understand

Claim

The written form you submit to the insurance company to receive payment for health care expenses.

Co-payment (or Co-pay)

Some insurance requires the patient to pay a fixed amount (e.g., $10, $25) for a service (e.g., office visit, prescription, emergency treatment) before the insurance is applied to the rest of the cost for that service.

Deductible

Some insurance companies require a person to pay a fixed amount in a year before the health insurance company starts picking up the bills. For example, an insurance policy may have a deductible of $400 per year for hospitalization; thus, if you are hospitalized, you must pay the first $400 of charges before insurance coverage begins.

You also need to know if your insurance covers 100% of costs after the deductible, or covers something less than 100% after the deductible. For example, if your plan covers 80% after a $400 deductible, you must pay the first $400 and then 20% of costs above $400.

Health Services Fee

Being seen (examined) by a Health Services provider is prepaid as part of the Health Services Fee. Every student is required to pay this fee, which pays for visits to Health Services, Health Education, Psychological Services; inpatient services; treatment and transport by Brown EMS (transport by any EMS other than Brown EMS, and costs incurred at the hospital are not covered by the Health Services Fee). Visits to dermatology consultant who comes to Health Services is prepaid under the Health Services Fee; however, lab work ordered by the consultant (such as examination of skin biopsy) is not covered by the Fee.

HMO

Health Maintenance Organization. A prepaid, managed-care, health care provider group providing health care services for a fixed fee to subscribers in a given geographic area. (2)

Health insurance company/carrier

The company that insures you for hospital stays, surgery, provider visits, immunizations, x-rays, lab tests, etc. Health insurance policies may or may not cover mental health care, prescriptions, dental care, eye care and prescription lenses.

Maximum Eligible Allowance (MEA)

Sometimes written "our allowance" on insurance statements, this is the price or charge the insurance company will allow for a particular service. Providers "in-network" have agreed to charge this price; providers "out-of-network" may charge more. If you go "out-of-network", the insurance company will determine reimbursement based on the in-network charge not on the price you actually paid. For example: if the MEA for an in-network office visit is $40 but you go out-of-network and pay $60, the insurance company will reimburse at 80% of $40 not 80% of $60. If you choose to go out-of-network, expect to pay more.

Out-of-Network

Your insurance plan may have a list of providers, labs, pharmacies, x-ray facilities, etc. designated as "in-network" or affiliated with the plan. Providers not on the list are "out-of-network". If you choose to obtain services out-of-network, the insurance will generally pay a lesser portion of the cost of the service. If you go out-of-network, be prepared to pay more. See "maximum eligible allowance" described herein.

Preauthorization

Insurance companies often require that a patient or provider notify them ahead of time of services desired (e.g., hospital admissions, surgery, mental health care). "Ahead of time" may mean 24-hours or several weeks. The company must pre-approve payment for the services.

Preexisting condition

Any health condition known to exist before a contract is made with the insurance company. Health care for preexisting conditions may not be covered at all until a specified amount of time has elapsed (e.g., 6 months). Often includes psychological therapy and treatment.

Primary Provider

Provider who provides most of your health care; your family doctor or provider. In this case, Health Services is your primary provider. You may also select one person in Health Services to be your preferred provider and see her/him every time (or almost every time) you come in.

Provider

Doctor, nurse, nurse practitioner, physician assistant or psychotherapist; lab, clinic, pharmacy, X-ray facility or hospital.

Referral

When your provider at Brown asks you to or suggests you visit a provider in order to receive services not offered at Brown. This is called making a referral. Many insurance companies require you to see your primary provider first to determine if your condition requires a specialist. In a managed-care system, the insurance may not pay for the services if you refer yourself to a specialist. See co-payment, out-of-network and maximum eligible allowance described here.

Subscriber

Person named as the owner of the policy. May be student, parent or spouse.

Term

The period of time the insurance policy is in effect; usually 12 months. The term of the Brown-sponsored plan is mid-August to mid-August; check for specific dates.

Term limit

The most the insurance will pay out for that specific category of costs in that term. This is an upper limit set by the insurance company. For example, if your surgery coverage is 80% of costs with a term limit of $5000, your insurance company will pay for 80% of any surgery costs you incur in that term up to $5000. You are responsible for the other 20% of costs; and after $5000 you are on your own, responsible for 100% of costs above the term limit.

Usual and customary charges

Usual and customary (U&C) or reasonable and customary (R&C) charges are determined according to average price charged for a given procedure by providers in a particular geographic area. This is another way insurance companies use to determine an approved fee for a given medical procedure. The amount the insurance will pay according to their U&C or R&C schedule may be less than the actual bill. The patient is responsible for paying the part of the bill above the company's U&C allowance.

Information and assistance at Brown University

How to choose your health insurance

Health insurance plans differ according to what they pay for, how much they pay, etc. When you choose a plan, you have to consider all of the variables and decide in what areas you want the most coverage and where you are willing to take some risks. You also have to decide how much you can pay for insurance. If you wanted everything covered to the utmost, the cost of your insurance might exceed your income.

References

(1) Novo Nordisk Pharmaceuticals, Inc. (1991). Inside Information on Health Insurance.

(2) Rowell, JoAnn C. (1994). Understanding Medical Insurance: A Step-by-Step Guide.New York: Delmar Publishers