This is a brief overview of covered services and payment levels of the product. It is not used to determine if your health care expenses will be paid. Only the written benefit plan governs the benefits available.
For premium rates and further details of the coverage, including definitions; exclusions; criteria for medically appropriate and necessary care; credentialing process; confidentiality policy; description of experimental drugs, medical devices or treatments; grievance and appeals process; provider listings; drugs eligible for coverage; reductions or limitations; and the terms under which this benefit plan may be continued, contact BCBSND Member Services toll free at 877.585.7551.
Year-Round Coverage (Including Breaks)
Your coverage continues as long as you remain enrolled with the minimum credit requirements each semester and your premium payments are current. The plan allows you to take one semester off during the calendar year.
Student Health Center (SHC) Services
There are benefits to using the SHC as your first point of care.
- When you use the SHC for treatment, cost sharing amounts are waived, except for prescription medication or drug copayment amounts.
- When you are referred to another health care facility by the SHC, ask for a referral to a participating BCBS provider so your copayment amounts will be waived for office visits and emergency services.
- If the SHC, campus nurse or health office is closed at the time of service due to holidays, vacations or breaks, or if you're away from school, get the services you need and then contact the SHC, campus nurse or health office for an authorized referral as soon as possible.
- No referral is required for maternity services or psychiatric and substance abuse services.
- No referral is given for chiropractic services; applicable copayment amounts will apply.
- Cost sharing amounts are not waived for eligible dependents.
- No SHC on your campus? Start with the campus nurse or health office. Ask them to authorize a referral to a participating BCBS provider. Then, when you visit the doctor or the emergency room, your copayment amounts will be waived. The school health office will need to file the referral with BCBSND.
- Waiting Period for Pre-Existing Conditions
- If you've had medical attention for a condition, disease, illness or injury within 6 months prior to your Student Blue effective date, it's known as a pre-existing condition. You'll be required to wait 6 months to be covered for services, supplies or charges for the care or treatment of a pre-existing condition. Members under age 19 will not be subject to a waiting period.
Qualifying Previous Coverage
Days of continuous coverage under qualifying previous coverage will apply toward the waiting period if continuous to a date within 63 days prior your Student Blue effective date under the benefit plan.
Your student health insurance coverage, offered by Blue Cross Blue Shield of North Dakota (BCBSND), may not meet the minimum standards required by the health care reform law for the restrictions on annual dollar limits. The annual dollar limits ensure that consumers have sufficient access to medical benefits throughout the annual term of the policy. Restrictions for annual dollar limits for group and individual health insurance coverage are $1.25 million for policy years before September 12, 2012, and $2 million for policy years beginning on or after September 23, 2012, but before January 1, 2014. Restrictions for annual dollar limits for student health insurance coverage are $100,000 for policy years beginning on or after September 23, 2012, and $500,000 for policy years beginning on or after September 23, 2012, but before January 1, 2014. Your student health insurance coverage put an annual limit of $500,000 on all covered services. If you have any questions or concerns about this notice, contact Blue Cross Blue Shield of North Dakota at the telephone number and address on the back of your ID card. Be advised that you may be eligible for coverage under a group health plan of a parent's employer or under a parent's individual health insurance policy if you are under the age of 26. Contact the plan administrator of the parent's employer plan or the parent's individual health insurance issuer for more information.