NAGPS Health Plan

(Last updated September 8, 2000.)

The National Assoc. of Graduate - Professional Students (NAGPS) is an advocacy group for graduate students. They endorse a health insurance plan offered to graduate students in most states (Massachusetts included). The NAGPS plan is beneficial in that it can cover for a period after leaving school and can cover domestic partners. On the down side, this plan may exclude certain pre-existing conditions.

IMPORTANT NOTE: The state currently requires student insurance plans to cover up to $25,000/year. Thus, the "Basic Plan" option below that covers up to $20,000 is not an option for students who are required to have a student insurance plan. Also, none of the plan options qualify for certain international students (such as J1 visa holders). Check with BU's Student Accounting Services if you have any questions about whether insurance you choose qualifies.

Qualifying

The NAGPS health plan is available to all degree-seeking graduate students and post-docs. It is not necessary for either individuals or the school's graduate organization to be members of the NAGPS to take advantage of this plan. The NAGPS' sister organization also has a plan appropriate for international students.

For additional cost, the plan covers dependents (children), a spouse or a domestic partner.

Cost

The cost of the insurance depends on 4 factors:

Here are costs for a student (under 35):

Basic Plan
($200 deductible)
With Major Medical
($200 deductible)
Basic Plan
($1,000 deductible)
With Major Medical
($1,000 deductible)
Student $564 $670 $364 $470
Student and Spouse/Domestic Partner $1,875 $2,087 $1,385 $1,597
Student and Children* $1,601 $1,918 $1,092 $1,409
Student, Spouse and Children* $2,912 $3,335 $2,113 $2,536
*Children refers to unmarried children under 19 years of age who are not self-supporting.

Here are costs for a student (35 or older):

Basic Plan
($200 deductible)
With Major Medical
($200 deductible)
Basic Plan
($1,000 deductible)
With Major Medical
($1,000 deductible)
Student $866 $972 $528 $634
Student and Spouse/Domestic Partner $2,835 $3,047 $2,049 $2,261
Student and Children* $1,903 $2,220 $1,256 $1,573
Student, Spouse and Children* $3,872 $4,295 $2,777 $3,200
*Children refers to unmarried children under 19 years of age who are not self-supporting.

These premiums have not increased since the 97/98 year, when these rates were established.

The premium may be paid in installments. There are also options to purchase coverage on a semi-annual or quarterly basis. In addition, those who have been under the insurance for at least 6 months may extend coverage for 6 months after graduation.

Coverage

You can use "most any doctor or hospital that you desire."

The deductible is waived when services are provided at your school's Student Health Services. There are no claim form, instead the students just must send medical bills to the insurance company in a timely manner.

The Basic Plan pays (after the deductible) 80% of usual and costumary charges for most common services up to a maximum of $20,000 for each injury or sickness. With the additional Major Medical coverage, costs beyond the $20,000 are paid 100% (up to a maximum lifetime limit of $250,000).

The following lists the main coverage of the insurance plan (it is not intended to be a complete list):

Outpatient Services

Service Coverage
Physician's Visit 80%
Diagnostic X-ray, Test and Lab Services 80%/$600 maximum (per policy year)
Prescription Drugs ($200 deductible plans only) 80%/$100 maximum
Surgeon's Fees 80%
Day Surgery Misc. (e.g., operating room, x-rays, etc.) 80%/$700 maximum
Assistant Surgeon 20% of Surgery Allowance
Anesthetist 25% of Surgery Allowance
Psychotherapy ($200 deductible plans only) $75 deductible per policy year
50%/$30 per day/$1,000 maximum per policy year
Physiotherapy 80%
Emergency Room 80%
Radiation Therapy and Chemotherapy 80%

Inpatient Services

Service Coverage
Room and Board/Hospital Misc. Expenses (e.g., medication, x-rays, etc.) 100%/$900 aggregate maximum per day
Intensive Care 100%/$1,300 aggregate maximum per day
Surgeon's Fees 80%
Assistant Surgeon 20% of Surgery Allowance
Anesthetist 25% of Surgery Allowance
Pre-Admission Testing 80%
Physician's Visits 80%
Registered Nurse's Services 80%/$12 per hour/90 days maximum

Pre-notification must be provided for hospital admission 5 working days prior to admission (for emergency conditions, it must be done within 2 business day after admission).

Other Services

Service Coverage
Consultant Physician Fees 80%
Ambulance 80%/$150 per trip
Dental Treatment (only due to injury to sound, natural teeth or fractured jaw) 80%
Braces and Appliances 80%
Alcoholism/Drug Abuse Paid as Psychotherapy
Elective Abortion 80%/$150 maximum
Maternity and Complications of Pregnancy Paid as any other Sickness

Prescriptions

Prescriptions are only covered when you choose the $200 deductible option. If so, they are covered at 80% up to a limit of $100 per illness.

Dental

Routine dental care is not covered.

Additional Information

Additional information, including a complete description of the benefits under this plan are available at http://www.sid.com/99_NAGPS. The NAGPS has answered a set of frequently asked questions about their plan. Also, you can request to be added to their mailing list for information specifically about the health plan.

You may inquire about the health plan by calling "Grad Services" at 1-800-767-0700. They may ask you for the policy numbers: #2000-485-01 for the $200 deductible plan (called the High Option) and #2000-485-02 for the $1,000 deductible plan (called the Low Option).


To contact the Graduate Student Organization on healthcare issues, send mail to healthcare@gso.bu.edu.
Disclaimer