Medical

Medical Plans

Harvard offers you a choice of several medical plans so that you can compare the options and select a plan that best meets your and your family’s needs and preferences. Plans are offered through two providers: Harvard's own Harvard University Group Health Plan (HUGHP) and Blue Cross Blue Shield of Massachusetts (BCBSMA). 

While both networks offer access to the same specialists, if you enroll in HUGHP, you will need to choose a primary care physician within the Harvard University Health Services or Atrius Health provider network. See how the two provider networks compare.

Notice: Transparency in Coverage Rule

In 2020, the Federal Government finalized “Transparency in Coverage” Rule, which requires health insurers and group health plans and sponsors to provide cost-sharing data to consumers via machine-readable files and consumer transparency tools.

Notice: Health Plan Resources for COVID-19; Certain Copayments Waived

Over-the-counter COVID test coverage:

If you are enrolled in a Harvard-sponsored BCBS or HUGHP medical plan, you and your enrolled dependents can be reimbursed for, and purchase or order – at no charge to you – up to eight at-home COVID test kits each per 30-day period through Express Scripts (ESI). Here’s how it works:

Purchase: Buy tests at any ESI network pharmacy, show your ESI ID card when you check out at the pharmacy counter (not the regular checkout lane), and the tests should ring up at no cost to you. To find a local ESI pharmacy, visit express-scripts.com and click “Find a Pharmacy.”

Be reimbursed: If you purchase at a non-ESI pharmacy or pay via the regular checkout lane, you can submit your receipts for reimbursement - up to $12 per test ($24 per two-pack). You can be reimbursed for test kits purchased on or after January 15, 2022.

Order: You may also order tests via mail order by visiting express-scripts.com.

Note: Reimbursement requests submitted to BCBS for eligible home test kits purchased January 15 through February 4, 2022 will be processed by BCBS. Tests purchased after February 4 must be submitted to Express Scripts. You cannot be reimbursed for the same kits through both BCBS and ESI.

As the University continues to work to address the needs of faculty and staff during the Coronavirus/COVID-19 public health emergency, Harvard in conjunction with its health plans will waive certain copayments.

Copayment waivers:

You are encouraged to take advantage as needed of the following convenient options that are open to both BCBSMA and HUGHP members that allow you to access treatment and information without visiting a clinical setting in person:

  • BCBS Well Connection. See licensed in-network doctors and providers for minor medical and behavioral health care using live video visits on your favorite device. Telehealth offers convenience (within the United States) as well as the opportunity to avoid potential exposure to contagion. Medical consultations 24/7. Learn more and how to access Well Connection. (Note that many telehealth copayments will be waived at this time, see below.)
  • HUGHP members who use HUHS may access telehealth appointments for urgent care, counseling/behavioral health and some other services. Learn more about HUHS telehealth and how to make an appointment.
  • BCBSMA has a dedicated coronavirus helpline at 888-372-1970 to answer questions about benefits, providers and other resources related to COVID-19. If you are a member with specific questions or concerns about your health or coverage, you should continue to call the BCBSMA phone number on the back of your member card.
  • POS/POS+ members with out-of-network behavioral health providers should contact BCBSMA directly at the phone number on the back of the member card if notified by providers that they are changing to telehealth appointments during the coronavirus emergency. BCBSMA will provide information on the process for filing claims.  
  • See a list of free wellbeing resources and behavioral health resources compiled by BCBSMA Health Engagement (note that these are not affiliated with BCBSMA).

Cost-share waivers:

  • Waive copayments, coinsurance and deductibles for medically-necessary testing, counselingvaccines and treatment provided at doctors' offices, emergency rooms and urgent care centers, and acute inpatient care consistent with the guidance issued by the Massachusetts Division of Insurance. Any medical treatment for COVID-19 is covered under a member's health plan within the U.S. and internationally.
  • Waive copayments, coinsurance and deductibles for telephonic and telehealth visits with an in-network provider, including Well Connection, for COVID-19 services. This is for both BCBSMA and HUGHP members (see note about out-of-network behavioral health services above).

Express Scripts, provider of pharmacy benefits for all Harvard medical plans, offers home delivery for medications

Plan options

Health Maintenance Organization (HMO)

With an HMO, you select a primary care physician (PCP) who coordinates your care and can provide you with referrals to in-network specialists. Out-of-network care is not covered, except in certain emergency situations. 

Point of Service (POS)

Like an HMO, you designate a PCP. However, you have the flexibility to use out-of-network providers for services, with higher out-of-pocket costs.

Preferred Provider Organization (PPO)

Available only to employees who reside outside New England through BCBSMA. Go to any health care professional you choose inside or outside your network without a PCP referral. You will have higher out-of-pocket costs for out-of-network care.

Also available to Faculty and Nonunion Staff

High-Deductible Health Plan (HDHP)

Featuring lower premiums and higher deductibles than a traditional health plan, the HDHP is offered in conjunction with a Health Savings Account (HSA). (External postdocs and stipendees are not eligible for this plan.)
 

POS Plus

With the same benefits as a traditional POS, the POS Plus plan has higher premiums and a higher out-of-pocket maximum in exchange for no deductible or coinsurance for in-network services. 

PPO Plus

Available only to employees who reside outside New England through BCBSMA. Same benefits as the PPO, but with higher premiums and a higher out-of-pocket maximum in exchange for no deductible or coinsurance for in-network services. 

Also available to SEIU members
Combined medical, dental and vision coverage through the SEIU for members and eligible dependents (domestic partners are not eligible). If you enroll in the SEIU plan, you cannot also be enrolled in Harvard’s dental or vision coverage.

Learn more by reviewing our Medical Plan Overview for 2022.

Prescription coverage

Prescription coverage is included in all Harvard plans and is provided through Express Scripts. Express Scripts offers a number of web- and app-based tools, including drug price comparison, signing up for mail order, downloading a member ID card and more. Learn how to make the most of these tools.

Certain medications used to prevent or manage the treatment of chronic medical conditions are available at a reduced or no cost under new federal guidelines (effective January 1, 2022). You can view a list of preventive medications in Harvard's plans for 2022 that are covered by this change and learn more in these Frequently Asked Questions

Prescription Copayment Assistance Program: 

Harvard offers a program through PillarRx Consulting, a prescription benefit consulting firm, that finds copay assistance programs that may be available from drug manufacturers for certain specialty medications. If you are prescribed an eligible medication, you will be contacted by PillarRx to facilitate enrollment in the manufacturer programs. To use the program, you must enroll and fill the prescription through Accredo, ESI’s specialty pharmacy. (Please note: Manufacturer assistance dollars may not accumulate toward deductibles and/or out-of-pocket maximums.)

Additional  plans

Global benefit program

For eligible employees working abroad. Learn more.

Retiree health programs

Benefits for employees who are in retirement.  Learn more.

Compare plan features and rates

To compare plans available to you, including rates and coverage options, please go to the Plan Rates & Features page and choose the information for your employee group. 

COBRA, Layoff, Global Plan and Ex-Spouse rates can be found under Forms & Documents  > Total Rewards > Health Benefit Rates. Rates for Domestic Partner can be found at Forms & Documents > Total Rewards > Domestic Partner.

Fitness/weight-loss reimbursement benefit

HUGHP and BCBSMA provide members with a reimbursement of up $150 per year toward membership at gyms/fitness facility or eligible weight-loss program. For 2021, this benefit also covers cardiovascular-related online fitness class subscriptions (fitness equipment is not covered). Check with your health plan provider for details about eligible expenses and reimbursement instructions. Español - Solicitud de reembolso por acondicionamiento físico.

SmartShopper

All faculty and staff enrolled in a Harvard-sponsored medical plan have access to an optional program, SmartShopper, that lets you compare costs for certain medical procedures and receive a financial incentive of up to $250 for using a preferred provider.

Prices for same quality medical services can vary by hundreds to thousands of dollars. When your doctor recommends a procedure or test, visit the SmartShopper portal (see flyer for portal links) or call the Personal Assistant team at 877-281-3722 to determine whether the procedure is offered at a convenient provider at a lower price. When you select a more cost-effective location, you will receive a financial incentive.

Sample incentives (many other procedures are included):

Health Care Service Financial incentives paid to participant (amount depends on provider selection)
Bone density scan $25-$50
Bunionectomy $50-$150
Cataract removal $50-$125
Colonoscopy $50-$250
CT scan $50-$75
Knee or shoulder arthroscopy $50-$250
Mammogram $25-$50
MRI $50-$100
Ultrasound (non-maternity) $50-$150

Payments are taxable and you will receive a 1099 tax form for reporting purposes from SmartShopper when you receive $600 or more in a year. Employees and dependents are eligible provided they are not also enrolled in Medicare or Medicaid.

Form 1095-C

Harvard is required under the federal Affordable Care Act (ACA) to provide Form 1095-C to active employees eligible for Harvard group health coverage in 2021, indicating that coverage meets the ACA's "Minimum Essential Coverage." 2021 forms will be mailed by the deadline of March 2, 2022. This form should be kept with your tax records (although you are not required to submit the form with your tax return). You can learn more here: