Choosing Medical Coverage
To assist you in choosing a medical plan, the College provides a comparison of benefits for each medical insurance plan offered. For a clear description of the medical plans, please refer to the appropriate descriptive booklets provided by each of the medical insurance carriers.

Waiving Medical Coverage
Bryn Mawr College requires benefits-eligible employees to have medical insurance because medical care costs can be enormous. Medical coverage provides financial security to meet these sometimes unexpected costs.

You may waive medical insurance only if you have group medical insurance coverage elsewhere and present the name and policy number of the plan on the Flexible Benefit Plan Election Form. If you have medical coverage, you may want to consider using your budget for other benefits.

In order to maintain continuance of a medical insurance waiver, you must make an election each year during the Open Enrollment. If this does not occur, the waiver will be rescinded.

Medical Plan Re-entry
If you waive the Bryn Mawr College Medical Plan because you have coverage under a spouse's plan, or other comparable medical insurance, you may join any of the medical options offered through the College's program if you lose that other medical coverage (See “Changes in Your Benefit Selection - Life/Qualifying Event Changes”). Confirmation of loss of coverage must be provided to Human Resources within 31 days of the termination date for the other medical coverage.

MEDICAL PLAN OPTIONS

Personal Choice PPO
Personal Choice is a Preferred Provider Organization (PPO) and is designed to allow you to choose your health care providers from a network. Unlike an HMO, you do not need to enroll with a primary care physician and you do not need a referral to see a specialist.

You receive maximum benefits by selecting physicians, specialists and facilities from the network directory.

Care can be obtained outside of the Philadelphia area on an in-network basis by using the BlueCard Ò PPO program. Prescriptions co-payments indicated are for a network pharmacy. A mail-order prescription program is also available.

There is a $20 co-payment for office visits to a primary care physician and a $30 co-payment for office visits to a specialist. Prescriptions obtained at a network pharmacy are subject to a $20 generic, $40 brand name formulary and $60 brand name non-formulary co-payment.

Inpatient and selected outpatient services obtained out of the network must be pre-authorized.

Keystone POS
Keystone Point-of-Service (POS) is a health care program which will give you the flexibility to receive referred care provided by your primary care physician or referred specialist at little or no cost or obtain self-referred care from a physician of your choice that can be reimbursed subject to a $200 deductible and coinsurance of 80% of reasonable and customary fees.

A POS plan is positioned between a PPO and an HMO. Like an HMO, you do need to enroll with a primary care physician. However, when you require care, - the “point-of-service” - you choose whether to seek that care through your primary care physician (referred care) or from any other provider (self-referred care).

A POS plan is similar to a PPO in that there is a high and a low level of coverage available. However, a POS plan requires that you enroll with a single primary care physician and that a referral be provided in order to receive the higher level of coverage. By contrast, you do not enroll with a primary care doctor in a PPO, and you can self-refer to an in-network specialist and receive the higher level of benefits in a PPO.

There is a $15 co-payment for office visits to your primary care physician and a $25 co-payment for office visits to a referred specialist. Prescriptions obtained at a network pharmacy are subject to a $15 generic, $35 brand name formulary and $50 brand name non-formulary co-payment. A mail-order prescription program is also available.

Keystone HMO
Keystone Health Maintenance Organization Plan (HMO) provides comprehensive health services including preventive care (routine visits) provided physicians and hospitals in the network are used and that the care is coordinated by a primary care physician.

There is a $15 co-payment for office visits to your primary care physician and a $25 co-payment for office visits to a referred specialist. Prescriptions obtained at a network pharmacy are subject to a $15 generic, $35 brand name formulary and $50 brand name non-formulary co-payment. A mail-order prescription program is also available. Except for emergency situations, no coverage is available unless your primary care physician has coordinated treatment.

COBRA (Consolidated Omnibus Budget Reconciliation Act)
Continuation of medical coverage is available through Bryn Mawr College to all qualified individuals under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), as amended. Coverage is available for the statutory periods at the employee's expense.

Women's Health and Cancer Rights Act
This 1998 federal law requires all group medical plans to provide coverage for the following services to an individual receiving plan benefits in connection with a mastectomy:

• Reconstruction of the breast on which the mastectomy has been performed;
• Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
• Prostheses and physical complications of all stages of mastectomy, including lymphedemas (swelling associated with the removal of lymph nodes).

The group medical plan must determine the manner of coverage in consultation with the attending physician and patient. Coverage for breast reconstruction and related services will be subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan.

Updated 09/10/2010
Bryn Mawr College