Health Benefits
MIT provides a variety of options to meet your health care needs.
Who Is Eligible
You are generally eligible for health coverage if you: (1) work at least 50% of the normal full-time work schedule in your department, laboratory or center; (2) are appointed to work at MIT for at least three months; and (3) are paid by MIT. You are also eligible if you meet the above criteria and have a visiting appointment or are a student in a cooperative education program working at MIT.
The following are not eligible: consultants, contractors, fellows, affiliates, teaching or research assistants, honorary lecturers, post-doctoral trainees, consultants and people paid by voucher and members of the armed services assigned to MIT.
If you are a member of a collective bargaining unit, all the provisions of the Health Plans are subject to the terms of your collective bargaining agreement.
Enrolling
You may enroll in a health plan within 31 days of your date of hire or appointment, or within 31 days of when you first receive your New Hire Kit, whichever is later. When you enroll, your coverage is effective as of your date of hire or appointment. The Benefits Office must receive your enrollment form within this 31 day period or you will generally need to wait until the next annual open enrollment period. Open enrollment for most benefits is held each fall.
Choosing Who Is Covered
When you enroll, you indicate who will be covered under the plan:
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Individual Coverage |
you
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Family Coverage |
you and your spouse or your same sex spousal equivalent, and your dependents under age 25
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Health Plan Options
MIT offers several health plan options to help pay for most types of medical care. These plans fall under two different categories - "health maintenance organizations" (HMOs), and "point-of-service plans" (POS plans).
MIT Medical Department
The MIT Medical Department is a large multi-specialty group practice that provides acute care, diagnostic testing, routine check-ups, and 24-hour urgent care. Most services of the Medical Department are available to those who work at MIT regardless of health insurance coverage. Consultation ("primary care") with an internist, general surgeon, nurse practitioner, physician’s assistant, psychiatrist or social worker is provided to members of the MIT community without charge. Consultations with specialists and laboratory tests are provided on a fee-for-service basis, unless you have health insurance that covers these services.
HMOs
When you join an HMO, you must use HMO doctors and facilities (except in the case of a life-threatening emergency outside of the HMO service area). You generally pay a small copayment for any care you receive. HMOs provide for most health care needs - including preventive and routine types of care.
The most significant difference among the various HMOs is in where you can receive care.
- The Traditional MIT Health Plan, Tufts Associated Health Plan, Network Blue New England. These plans operate through a network of medical professionals. If you join one of these plans, you choose a physician from the network of physicians associated with your plan or one of the staff physicians at a designated health center. If you require specialty care, your primary care physician (PCP) will refer you to a specialist who is usually within your PCP’s same hospital group.
With HMOs, you need to designate a PCP to coordinate your care, provide routine care, and refer you to specialists within the same group of providers, or "network," if needed.
POS Plans
When you join a POS plan, you may receive care within the plan’s network and pay small copayments, or you may receive care outside the network and pay a deductible and copayments.
- The Flexible MIT Health Plan. When you need medical services or supplies, you can either use the health care services available through the MIT Medical Department and by referral from your plan physician, or you can arrange your own care through any Blue Cross/Blue Shield health care provider. When you arrange your own care, you will pay a portion of the cost over and above your regular premium contribution. You receive reimbursement from the plan after satisfying the annual deductible and copayments.
- The Blue Choice Plan. This plan offers the advantages of an HMO when you seek care in-network (managed care, low out-of-pocket costs, etc.) through a broad selection of Blue Cross and Blue Shield providers. You also have the freedom to use out-of-network providers whenever you like. When you choose to receive care out-of-network, you pay more in the form of deductibles and copayments.
If You Reside Outside Massachusetts
If you reside outside Massachusetts, you may be eligible to enroll in one of the HMOs or point-of-service plans. Otherwise, you may enroll in a Blue Cross and Blue Shield indemnity plan that is only available to out-of-state residents.
Under the indemnity plan, you may choose your health care providers from a broad network of Blue Cross and Blue Shield participating doctors and hospitals - you are not limited to certain physicians or facilities. In exchange, you may be responsible for paying a part of the cost of your care through the plan’s deductibles and copayments. Some preventive and routine types of care are not covered.
Cost
You and MIT share in the cost of your health coverage. Your share will be paid with before-tax dollars that are deducted from your pay each pay period. Your cost depends on whether you choose individual or family coverage, the cost of the option you elect and your employment category. For details on rates, please see the Benefit Choices rate sheet available in the Benefits Office.
If You Want to Make Changes
In exchange for allowing you to pay your premium with before-tax dollars, Internal Revenue Code regulations do not allow you to cancel or change your health coverage midyear unless you have an allowable change in family or employment status. Your benefit change must be on account of and consistent with your family or employment status change. A list of examples of allowable status changes is available in the Benefits Office.
If you do have an allowable change in family or employment status, you must contact the Benefits Office within 31 days to make any corresponding benefit changes. Your change will be effective on the date of the allowable event.
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