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Human Resources

Health Plan

stethYour health plan covers many medical expenses such as doctor visits, lab tests, medications, medical treatments and mental health benefits. The Bowdoin College Health Plan is a Preferred Provider Organization (PPO) provided through Anthem.

Am I eligible?

All regular benefits eligible employees working 20 or more hours per week can be part of the Health Plan.  You have 60 days from your date of hire to enroll and coverage begins retroactive to your date of hire.

How much does it cost?

The monthly costs made (via payroll deduction) on a pre-tax basis are as follows:

Annual Salary of $43,000 and Under   Employee Contribution (per month) College Subsidy (per month) Full Cost (per month)
Employee $69.00 $598.07 $667.07
Employee + Spouse/Partner $320.00 $1152.05 $1472.05
Employee + Child(ren) $231.00 $838.56 $1069.56
Employee + Family $320.00 $1152.05 $1472.05
Annual Salary of $43,001  and Over   Employee Contribution (per month) College Subsidy  (per month) Full Cost (per month)
Employee $73.00 $594.07 $667.07
Employee + Spouse/Partner $341.00 $1131.05 $1472.05
Employee + Child(ren) $248.00 $821.56 $1069.56
Employee + Family $341.00 $1131.05 $1472.05



*If you have an annual salary less than $43,001, you may be eligible for a Health Reimbursement Account (HRA) which can be used for certain expenses associated with the Health Plan. 

What does it cover?

Bowdoin College offers a very rich plan that includes coverage for:

  • Primary Care Physician Office Visits
  • Specialty Physician Office Visits
  • Preventive Care (such as routine physicals, health screenings and well child visits)
  • Hospital Visits
  • Mental Health
  • Routine Eye Exams (limited – see the EyeMed Vision Plan for more robust coverage)
  • Medical Tests (such as X-ray and lab services)
  • Prescription Medications

Bowdoin College Benefit Summary Chart for 2014

The Summary Plan Description contains more detailed descriptions.  You can also find helpful explanations of terms below.

Helpful terms and definitions

Before you get started, there are a few terms you will want to understand.

Preferred In-Network –  Bowdoin College works with a group of health care providers known as “Preferred In-Network” providers with additional cost savings.  At this time, the Preferred In-Network providers include Mid Coast Hospital (Brunswick), Maine Medical Center (Portland), Maine Heart Center (Portland) and OA Centers for Orthopaedics (all locations).   Mid Coast Hospital was recently recognized for demonstrating sustained high performance in health care delivery over a 5-year period.  You can learn more here.

In-Network – Anthem has contracts with many providers in Maine and across the United States, known as “In-Network” providers.   Anthem has special rates with these providers, so if you go to an In-Network doctor or hospital you will be able to pay less out of pocket.  You can see who is on the list of network providers at Anthem’s website.

Out-of-Network – Since Bowdoin College offers a PPO plan, you do not have to go to an In-Network or Preferred-In-Network provider if you do not wish to.  However, because Out-of-Network providers do not have a contract with Anthem, it will cost more for both you and the College.  It is important to understand that if you receive services from an Out-of-Network doctor or hospital, the health plan will pay benefits based on the “maximum allowances.”  This means that any amount that an Out-of-Network doctor or hospital charges that is above the maximum allowance will be billed to you directly before the Out-of-Network benefits begin to pay.  This can mean significantly higher out-of-pocket costs to you.  For example, if an Out-of-Network doctor charges $175 for an office visit and the maximum allowance is $100, you will have to pay $75 before the deductible and coinsurance are applied.

Deductible - The deductible is the amount of money you need to pay before the insurance pays.  The In-Network deductible on the health plan is $400 for an individual or $800 for a family.  For many of the services covered by the health plan, you will need to meet your deductible before the benefit applies.

Copayment (Copay) - For some services and for prescription drugs, you will have to pay a copay.  A copay is the amount of money you pay for a service, separate from your deductible.  Your copay is usually a small percentage of the overall cost, especially if you use In-Network providers.   For example, if you go to an In-Network primary care doctor, you pay $15 and the insurance company pays the rest (which typically ranges from $100-$170 in Southern Maine).  Copays are a set dollar amount.

Coinsurance – Coinsurance is the percent of the cost of your care that you need to pay after you have paid your deductible.  For In-Network services, the co-insurance is 10% and for Out-of-Network services it is 30%.

Out-of-Pocket Maximum – The “Out-of-Pocket” maximum is the total amount of money (deductible plus coinsurance) that you will pay for medical services in a benefit year (calendar year).   Benefits are paid at 100% for the remainder of the calendar year once you have reached your out-of-pocket maximum.  Out-of-Network charges that are in excess of the maximum allowance do not count toward your out-of-pocket maximum.   The in-network out of-pocket calendar year limit in 2013 is $2,000 per individual/$4,000 per family.

Example:

Joan has elected health insurance coverage for just herself at Bowdoin.  She needs to have an MRI on her knee.  The Benefits Summary shows that an MRI is a high-tech diagnostic service that needs pre-authorization, which she has already received from her doctor’s office.  Insurance will cover 90% of the cost after her deductible has been met.   Since she has decided to have the MRI at Maine Medical Center (a preferred In-Network provider), there is no deductible, so she will need to pay 10% of the total facility cost in coinsurance.

How do I use the plan?

Below you can find basic explanations of commonly used services and tips for using the health plan.

Doctor Visits – The plan has different co-pays for primary care (your personal or family doctor) or specialist visits and for doctors that are In-Network.   Out-of-Network office visits and other services are paid at 70% after the deductible and coverage is subject to the maximum allowances for the plan.  For In-Network primary care office visits, the co-pay is only $15 and for In-Network specialists it is $40 per visit.  You do not need to pay a deductible or coinsurance on regular In-Network office visits (such as going to your primary care doctor when you are sick).

Laboratory Tests and X-rays – Lab tests and x-rays are subject to your deductible.  Once your deductible is met, you will pay 10% of the total cost at In-Network providers.

Prescription Medications – Bowdoin College has a tiered drug plan, which means your co-pay will depend on the type of drug your doctor prescribes. 

  • Tier 1 - $10 copay for a 30-day supply (includes generic drugs and some brand name medications used to manage chronic health conditions)
  • Tier 2 - $30 copay for a 30-day supply (includes brand name drugs without a generic equivalent)
  • Tier 3 - $50 copay for a 30-day supply (may include more costly medications or medications very recently approved by the Food and Drug Administration)

Non-Conventional Therapy - Acupuncture

  • Acupuncture:  Benefits are provided for covered services received from a licensed provider in calendar year 2015.  The plan pays 60% after the deductible and there is a 20 visit limit per calendar year.  There are no acupuncture providers in Anthem’s network.  For this reason, you must pay the provider upfront and submit an Anthem claim form along with the receipt from the provider for reimbursement.  Please be certain that the receipt from the provider lists his/her name, address, date of service, amount charged, procedure code and lists the medical diagnosis requiring treatment 

How does our prescription plan work?

Bowdoin College has a tiered drug plan, which means your co-pay will depend on the type of drug your doctor prescribes. 

  • Tier 1 - $10 copay for a 30-day supply (includes generic drugs and some brand name medications used to manage chronic health conditions)
  • Tier 2 - $30 copay for a 30-day supply (includes brand name drugs without a generic equivalent)
  • Tier 3 - $50 copay for a 30-day supply (may include more costly medications or medications very recently approved by the Food and Drug Administration)

You can easily review a list of what drugs are included in the Anthem prescription drug list or formulary.   You do not need to meet your deductible for prescriptions – only the co-pay applies.  Some prescription medicines may need to be reviewed to make sure they are appropriate, safe, and affordable for you and are covered by our plan.  Read more about Anthem's Step Therapy and Prior Authorization.

TIP:  If you are taking a drug that you can buy through Anthem’s Mail Order Pharmacy Program, you can save money and Bowdoin saves money.  Certain local retail pharmacies (Hannaford, CVS, Rite-Aid, Osco, erc.) will honor the mail order discount as well.  The Mail Order Program allows you to receive a three month supply of your prescription and only pay two copays instead of three.

Preventive Care Services

Preventive Care – Preventive care services are offered at no cost.  Routine physicals, mammograms, Pap smears, and colonoscopies are covered at 100% when they are done as part of a recommended screening schedule.  The recommended screenings and immunizations can change depending on your gender, age, and family health history.   For example, young children up to age 4 will receive dental fluoride varnish at well child visits with their health care provider as a new preventive service offered in 2012.

Enhancements to Women's Preventive Services for 2013 - Health Care Reform will provide enhancements to women’s preventive services covered at 100% including:  Well Women exams, prescription contraceptives (generics and brand name drugs with no generic equivalent), sterilization procedures and patient education/counseling for women, breastfeeding support, supplies and counseling, etc.   Services must be obtained from an in-network provider for 100% coverage.

Be sure to ask your doctor if any preventive screenings are recommended for you.

Preventive Care Services Video:

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Other services: ConditionCare and Smoking Cessation

If you suffer from a chronic health condition requiring ongoing care...

If you or a covered family member has one of the following chronic health conditions (asthma, diabetes, chronic obstructive pulmonary disease, coronary artery disease and heart failure), you are eligible to join Anthem’s ConditionCare Program.   Your participation in the ConditionCare Incentive Program provides the following additional benefits:

  • The medication you take to treat your condition may be available with no co-pay or at a reduced co-pay.
  • Doctor visits that are for treatment of the condition do not require you to pay a co-pay.

ConditionCare Video:

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Check out frequently asked questions about the ConditionCare programs, then call Anthem (1-866-596-9812) to engage in the program that's right for you.

If you use tobacco….

If you want to quit tobacco, the Bowdoin College Health Plan offers several benefits for you:

  • Doctor office visits for the purpose of tobacco cessation have no co-pay
  • Hypnosis is covered at 100% after a $15 co-pay
  • You can get reimbursed if you complete a smoking cessation program referred by your healthcare provider

How do I contact Anthem or find claim forms?

Anthem
P.O. Box 533
North Haven, CT  06473
1-800-527-7706
www.anthem.com/bowdoincollege

You can also download a medical claim form or prescription drug claim form.

Bowdoin College Health Plan Benefit Summary Chart and Plan Documents

Federal Benefit Summary Chart for 2014 - Under the Patient Protection Affordable Care Act (PPACA) or Health Care Reform, we are now required to distribute a new Summary of Benefits and Coverage document.  It is intended to provide you with an easy-to-understand summary about the health plan’s benefits and coverage.  During this year, Human Resources will also maintain and update our standard Health Plan Benefits Summary document below.

Bowdoin College PPO Health Plan Document

Bowdoin College PPO Health Plan Document - First Amendment

Bowdoin College Benefit Summary Chart for 2014