If you elect a POS or POS Plus Plan, you have the option of using out-of-network benefits.

With out-of-network benefits you can arrange care without a referral or choose a provider who does not participate in the Harvard University Group Health Plan network. When you choose to receive care out-of-network, you have higher out-of-pocket costs. Services out-of-network will be reimbursed based on an allowed charge.¹ If your out-of-network provider charges more than the allowed amount, you may be billed for the difference. This is called balance billing.

POS and POS Plus Members

POS and POS Plus members have the option of managing their own health care and receiving health care and services from providers who are not in the Harvard University Group Health Plan network. If you decide to use your out-of-network benefits, your out-of-pocket costs will be higher and you may also be balance billed for the difference between the actual charges and the Blue Cross Blue Shield of Massachusetts allowed amount for covered services.

To receive the highest level of coverage, you should obtain your health care services and supplies from covered providers who participate in the Harvard University Group Health Plan provider network. For some health care services, you may need a referral from you in-network HUGHP primary care physician or approval from your health plan in order to receive in-network coverage.

Claims Process

If you elect to use your out-of-network benefits, you may have to pay for covered services rendered and file for reimbursement using this Blue Cross Blue Shield of Massachusetts claim form. Once you have met your deductible, you will be reimbursed for covered services minus your applicable coinsurance. You can view the status of your claim at Blue Cross Blue Shield MyBlue - it can take up to 60 days to process a claim. You will need to create a secured login to view your claims status. Learn more about the claims process.

¹ The "allowed" charge is what Medicare pays for the same service, plus 50 percent. If there is no established Medicare reimbursement rate, HUGHP will base its payment on similar payments for providers in that area.