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Frequently Asked Questions about Student Health Insurance

Important Contact Information

I have questions about what is covered, how to access benefits, enrollment concerns, or replacement ID cards.

Gallagher Koster
500 Victory Road
Quincy, MA 02171
Website: www.gallagherkoster.com/bostonconservatory
Phone: 1-800-406-4912
Email: conservatorystudent@gallagherkoster.com

I have questions about a specific claim or claims payment.

UnitedHealthcare StudentResources
P.O. Box 809025
Dallas, TX 75380-9025
Website: www.uhcsr.com
Phone: 1-866-563-3484
Email: gkclaims@uhcsr.com

How can I find a Preferred Provider?

Harvard Pilgrim (Regionally in MA, NH, and ME)
United Healthcare Options PPO (Nationally)
Go to www.gallagherkoster.com/bostonconservatory and click on 'Find a Doctor'

How can I find a Participating Pharmacy?

UnitedHealthcare Network Pharmacy
Go to www.gallagherkoster.com/bostonconservatory and click on 'Pharmacy Program'

How do I learn more about Gallagher Koster Complements?

EyeMed Discount Vision Plan
Website: www.enrollwitheyemed.com
Phone: 866-839-3633

Basix Dental Savings and CampusFit
Website: www.basixstudent.com
Phone: 888-274-9961

How do I learn more about Worldwide Assistance Services?

Travel Assistance Services
Scholastic Emergency Services (SES)
Toll-free in the US 877-488-9833
Collect outside of the US 609-452-8570
How do I contact the 24-Hour Nurse Line?
Phone: 1-877-488-9833

Enrollment & Eligibility

Who is eligible for the plan?

Enrollment in a health insurance plan is required for all registered undergraduate and graduate students taking ¾ of full-time credit hours or more at the Boston Conservatory. To ensure compliance with this policy, students (as defined below), are automatically enrolled in and billed for the Student Health Insurance Plan unless proof of comparable insurance coverage is documented.

Documentation is provided by completing a waiver form identifying the in-force comparable coverage and submitting it by the posted deadline. If a form is not submitted by the deadline, the student will remain enrolled in the Student Health Insurance Plan for the policy year.

  • All registered Undergraduate and Graduate students taking ¾ of full-time credit hours or more are automatically enrolled in and billed for the Student Injury and Sickness Insurance Plan.
  • Students taking at least 6 credits are eligible to purchase coverage through the Bursar's Office, but are not automatically enrolled in the Plan.
  • Eligible dependents of insured students can also be enrolled in the Student Injury and Sickness Insurance Plan for an additional cost.

How do I enroll?

All eligible students who do not submit an online waiver by the deadline will be automatically enrolled in the student insurance plan.

How do I enroll my eligible dependents?

Students must purchase coverage for their eligible dependent(s) at the same time as their own initial plan enrollment. Dependent coverage must be purchased for the same time period as the student's period of coverage and cannot exceed coverage purchased by the student. For example, a student enrolled for annual coverage cannot purchase dependent coverage for the spring semester unless a qualifying event, as defined below, occurs.

Students can add eligible dependent(s) if they experience one of the following qualifying events: (a) marriage, (b) birth of a child, (c) divorce, or (d) if the dependent is entering the country for the first time. Please note, with the exception of the dependent entering the country for the first time, all other qualifying events noted above will only be approved if experienced by the student. If dependent enrollment meets one of these qualifying events, the Dependent Enrollment Form, supporting documentation and payment must be received by Gallagher Koster within 31 days of the qualifying event. If not received within 31 days of the qualifying event, the effective date of coverage will be the date this form and payment are received at Gallagher Koster. Once a dependent is enrolled, coverage cannot be terminated unless the student loses eligibility.

Students may enroll their eligible dependents online for an additional premium by visiting www.gallagherkoster.com/bostonconservatory, selecting 'Dependent Enroll', and completing the form by the published deadline.

Can I waive the student health insurance plan with any of the insurance plans offered through the Commonwealth Connector?

Students are not eligible for any of the subsidized Commonwealth Care programs and these programs cannot be used to waive the student health insurance plan. Students are eligible for the insurance plans offered through Commonwealth Choice, but these plans should be reviewed carefully as they may have very high deductibles and often times limited benefits.

Is there anything I need to know before waiving coverage?

Before waiving you should review your current policy, considering the following:

  • Will your current plan cover medical care beyond emergency services (i.e. doctor's office visits, diagnostic testing, x-rays, prescription drugs, etc.) in the Boston, MA area?
  • Does your plan have doctors and hospitals in the Boston, MA area?
  • Check the cost -- is the annual cost of this Student Plan less expensive than the cost of being added as a dependent to your parents'plan? Be sure to compare deductibles and total out-of-pocket costs, not just the annual premium.
  • Are there administrative pre-requirements, pre-certification, or Primary Care Physician referrals required under your current plan that may delay receipt of care?

What about Health Care Reform? How does that affect my Student Health Insurance Plan?

If you are under the age of 26, you MAY be eligible to enroll as a dependent under the employer health insurance plan held by your parent(s). However, before you do so, you should fully compare the employer plan against this Student Plan to determine which plan's rates, benefits and coverage are most appropriate for you.

In addition to the items mentioned above, keep in mind that Student Insurance Plans are generally less expensive than individual plans with similar benefits. In fact, your total out-of-pocket cost (including premium and deductibles) may be significantly LESS with this Student Plan, especially if your parents' employer plan is considered a 'high deductible' plan.

How do I waive coverage under the student health insurance plan?

If you determine your coverage to be comparable and would like to waive the student health insurance plan:

  • Go to www.gallagherkoster.com/bostonconservatory.
  • Click on 'Student Waive' link.
  • Create a user account. When creating your account, please enter your First Initial combined with your Full Last Name and your year of birth in the Student ID field.
  • Select the Red 'I want to Waive' button. When waiving the insurance, have your current health insurance ID card ready as you will need this information in order to complete the waiver form. After completing your online form you will be asked to review your information and click 'Continue'. Immediately upon submitting your online form you will receive a confirmation number. Please save this number and print a copy of the confirmation for your records.

Please Note:

International students can only waive the Student Injury and Sickness Plan if they are covered by a comparable insurance plan based in the United States. Embassy sponsored plans are not accepted as comparable coverage.

Insurance Plan Benefits

What changes have been made to the plan for the 2012-2013 Policy Year?

  • The student health insurance plan is compliant with the first phase of healthcare reform as ruled by the US Department of Health and Human Services.
  • As a result, the following changes have been made:
    • The maximum benefit is now $100,000 per Injury or Sickness.
    • Internal limits have been removed for:
      • The Prescription Drug Maximum ($1,000)
      • The Outpatient Miscellaneous Maximum ($2,000)
      • The High Cost Procedure Maximum ($2,000)
      • The Out-of-Network Surgery Maximum ($5,000)
      • The Ambulance Expense Maximum ($150 per trip)
  • A new comprehensive Preventive Health/Wellness Benefit has been added, with services paid at 100% to In-Network only with no cost-sharing (no copayments or deductibles). Preventive Health/Wellness Benefits include, but are not limited to, routine physical exams, routine GYN exams, preventive screening and testing, immunizations and travel immunizations.
  • In addition:
    • The service provided by a Preferred Provider is now covered at 90% of Preferred Allowance after a $50 deductible per insured, per policy year. (Other limitations may apply. Please see brochure for full details)
    • The Out-of-Network deductible has increased from $100 to $200 per insured, per policy year
    • The copayment for Physician Office Visits and Consultant Visits has increased from $15 to $25 per visit
    • The Ambulance Expense is now covered at 80% of the Preferred Allowance
    • The Durable Medical Equipment maximum has increased from $500 to $1,000 per Policy Year for non-essential DME.
    • The maximum benefit for injury to Sound, Natural Teeth has decreased from $1,000 to $500 per Policy Year

What is covered under the Student Injury and Sickness Insurance Plan?

  • The plan offers comprehensive benefits that include hospital room and board, inpatient and outpatient surgical procedures, labs and x-rays, chemotherapy and radiation, inpatient and outpatient mental health services, physician office visits, consultant visits, ambulance, emergency care, and prescription drugs.
  • The maximum benefit allowed for each injury or sickness is $100,000, however there are copayments, coinsurance, and deductibles within the plan. As a result, students should refer to their brochure schedule for details
  • Services provided by an In-Network Provider are generally covered at 90%, while services provided by an Out-of-Network Provider are generally covered at 70%.
  • There is a $50 deductible for In-Network Providers and a $200 deductible for Out-of-Network Providers per policy year.
  • Comprehensive Wellness Benefit covered at 100% to In-Network Providers only, with no cost-sharing.
  • Please refer to the plan brochure available at www.gallagherkoster.com/bostonconservatory and click on 'My Benefits and Plan Information” for complete details about coverage, limitations, and exclusions.

How much does the plan cost?

  Annual Coverage- Undergraduates
9/1/13 to 8/31/14
Annual Coverage- Graduates
9/1/13 to 8/31/14
Student $1,390 $1,691
Spouse $3,413 $3,413
Per child $2,257 $2,257

How do I get my prescriptions filled?

  • Prescriptions can be filled at a UnitedHealthcare Network participating pharmacy. To find a list of participating pharmacies near you, visit www.gallagherkoster.com/bostonconservatory and click on 'Pharmacy Program'.
  • At designated UnitedHealthcare Network pharmacies (which is the network of Medco participating pharmacies), you will paya $15 co-payment for a 30-day supply of a Tier-1 drug, a $30 co-payment for a 30-day supply of a Tier-2 drug, and a $50 copayment for a 30-day supply of a Tier-3 drug, up to the policy maximum.
  • Prescriptions are also available through a Mail Service Program. Through the Mail Service Program you will pay 2.5x the cost of a 30-day supply for a 90-day supply of your prescription drug. Click on 'Pharmacy Program' at www.gallagherkoster.com/bostonconservatory to learn the details of the pharmacy program, including the Mail Service Program. Students who take maintenance drugs are encouraged to use the Mail Service Program to be able to receive the maximum benefit available.
  • Outpatient medications for treatment of a Covered Expense are covered prescriptions. If the treatment of a medical condition is limited or excluded from the plan, the outpatient prescription is likewise limited or excluded.
  • Students who plan on studying abroad may fill out a Prescription Override form by visiting www.gallagherkoster.com/bostonconservatory and selecting 'Pharmacy Program', then 'Pharmacy Override Form'.

Am I covered if I have a pre-existing condition?

Students under the age of 19 are immediately covered for pre-existing conditions.

If you are over the age of 19, you will be covered if you were continuously insured through another health insurance plan for the 6 months immediately prior to the effective date of the Student Injury and Sickness Insurance Plan without a lapse in coverage of more than 63 days.

  • If you were not continuously insured or had a lapse in coverage of more than 63 days, you will not be covered for any preexisting condition. A pre-existing condition is one for which you sought medical advice, were diagnosed, received care or treatment, or were recommended care or treatment during the 6 months prior to the effective date of this plan.
  • Once you have been enrolled in this plan for 6 months, your pre-existing condition will be covered as any other condition.

Am I required to get a referral from my school's Health Services before I seek treatment?

No, a referral is not required with the Student Injury and Sickness Insurance Plan.

Do I get an ID card?

Yes, ID Cards are made available online at www.gallagherkoster.com/bostonconservatory . They are also distributed during Fall orientation for new students. ID cards will be available in the Wellness office for the week following orientation, then distributed to student mailboxes.

How do I print an ID card online?

  • Go to www.gallagherkoster.com/bostonconservatory.
  • First time users will need to create a User Account. Create a user account. When creating your account, please enter your First Initial combined with your Full Last Name and your year of birth in the Student ID field.
  • On the Left toolbar, under 'My Account', click on 'Authorize Account'.
  • Enter your Student ID number and your date of birth and click on 'Authorize Account'.
  • You will be redirected to the 'Account Home' page, then click on 'Generate ID Card'.

Does this plan cover me when I am off campus, traveling or studying abroad?

Yes, the Student Injury and Sickness Insurance Plan covers you during semester breaks, summer vacation and even if you're traveling or studying abroad. You'll be covered for the period for which you paid premium.

In addition to being covered for medical treatment and services, you will also be covered for Repatriation of Remains, Emergency Medical Expense Benefit and Travel Assistance Services through Scholastic Emergency Services, Inc., the 24-hour worldwide assistance service. All services must be arranged for in advance and provided by Scholastic Emergency Services, Inc. Any services not arranged by Scholastic Emergency Services, Inc. will not be considered for payment.

  • When studying or traveling abroad, keep your student health insurance plan identification card with you and take a copy of the brochure for reference.
  • When outside of the United States, you will likely be asked to pay for your medical care first and will then need to seek reimbursement. Covered Expenses will be reimbursed on an out-of-network basis.
  • When you submit claims for reimbursement, you will need to have the itemized bill(s) translated into English and include a letter informing the claims administrator that you are seeking reimbursement for charges previously paid.
  • Please ensure that your name, ID number, address (to receive your reimbursement check), and the University's name are on the bill.

What is a deductible? Does this plan have a deductible?

A deductible is the amount for which you are responsible before payment is made by the claims company. Once you have paid the deductible, whether it's applied to one service or multiple services, the plan will pay for covered medical expenses as indicated in the plan brochure.

This plan has a $50 per insured, per policy year deductible that applies to services received from a Preferred Provider. There is a $200 per insured, per policy year deductible that applies to services received from an Out-of-Network Provider.

Finding a Provider

Can I go to any doctor or hospital?

Yes, you can go to any provider; however, you will save money by seeing providers that participate in the Harvard Pilgrim Network because providers participating in this network have agreed to accept a predetermined negotiated amount, or Preferred Allowance, as payment for their services.

Go to www.gallagherkoster.com/bostonconservatory and click on 'Find a Doctor' to locate participating providers.

Claims Processing

What should I do if I receive a bill, or need to be reimbursed, for services I received?

Physicians should bill the claims administrator. The billing information is on the back of your health insurance ID card. However, if you do receive a bill or if you have paid for a service and need to be reimbursed, please send your bill (and proof of payment if seeking reimbursement) to the claims administrator. You do not need an additional claim form. Make sure your name, health insurance ID number, and school name are on the bill. Make a copy for your records before sending to the claims administrator at the following address:

UnitedHealthcare StudentResources
P.O. Box 809025
Dallas, TX 75380-9025
Website: www.uhcsr.com
Phone: 1-866-563-3484
Email: gkclaims@uhcsr.com

Is any other information needed in order to pay a claim?

If the treatment you received was a result of an accident, you will receive a letter from the claims administrator asking for information about the accident, i.e. was it the result of a car accident, from playing sports, etc. Your claim cannot be processed without this information, so please respond to the letter promptly. You may also receive a letter asking if you are covered by any other health insurance plan. It is important that you respond promptly to this as well.

How will my claims be paid if I have other health insurance in addition to the student health insurance plan?

The Student Injury and Sickness Insurance Plan has a coordination of benefits provision. This means your plan with Gallagher Koster will coordinate the payment of claims with your other insurance company. You will need to provide the claims company with information about your other health insurance company.

Please refer to your brochure for details.

Plan Enhancements

What enhancements are available under this plan?

Exclusively from Gallagher Koster, enrolled students have access to a menu of products at no additional cost. More information is available by visiting www.gallagherkoster.com/bostonconservatory and clicking on the 'Discounts and Wellness' link.

Will I be covered under the plan after I graduate?

Yes, you will be covered under the student health insurance plan until the end of the policy year.

Can I continue coverage after the policy terminates?

No, there is no option to continue coverage after this policy terminates.

Are there any additional insurance products available?

Please visit www.gallagherkoster.com/bostonconservatory and click on the 'Other Insurance Products' link for complete details about additional insurance products that are available as well as enrollment information.

This document is only a summary of the benefits available. Please refer to the Summary Plan Description for a description of the benefits available and exclusions and limitations of the plan.

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