The Claims Company is the organization that pays insurance claims on behalf of the insurance company. Mail Order service may also be available, allowing up to 90 days of a maintenance medication to be delivered directly to you.Ĭlick the Pharmacy Program link for more information on the specific Pharmacy Benefit Manager for your School’s Student Health Insurance Plan. The specific cost or tier-level of a particular drug may change over time, and the formulary governing your insurance plan may change 2-4 times a year. Your health insurance plan brochure will contain information about costs associated with various tiers of prescription drugs, and then you can the links to your plan’s lookup tools to determine your out-of-pocket cost. Additionally, the Pharmacy Benefit Manager will identify what your cost will be for any drug that you may be prescribed (referred to as the plan “formulary” or “Prescription Drug List/PDL”). Your Insurance plan’s Pharmacy Benefit Manager identifies where you can have your prescriptions filled (“participating pharmacies”), including both national chain and local pharmacies. Network participation is subject to change, so please verify with the provider that they are participating in the network when making an appointment or at the time of service. Receiving services or care from an Out-of-Network provider at a Preferred Provider hospital does not guarantee that all charges will be paid at the Preferred Provider level of benefits.Ĭlick the Find a Doctor box for more information on the specific Preferred Provider Network applicable to your school’s Student Health Insurance Plan. Note: An insured person should be aware that Preferred Provider hospitals may be staffed with Out-of-Network providers. When using Preferred Providers, out-of-pocket expenses will be less. The advantage to using a Preferred Provider is that these providers have agreed to accept a predetermined fee (or “Preferred Allowance”) as payment for their services. What is a Preferred / In-Network Provider?Ī Preferred Provider is a doctor, hospital, or other health care provider that is contracted to participate in a specific network of providers.
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