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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.

Arthur J. Gallagher & Co.
500 Victory Road
Quincy, MA 02171
Website: www.gallagherstudent.com/bostonconservatory
Phone: 1-800-406-4912
Email: conservatorystudent@gallagherstudent.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 Student 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

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.gallagherstudent.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 2014-2015 Policy Year?

The Student Health Insurance Plan is compliant with the final phase of healthcare reform. The maximum benefit per policy year is now unlimited. Pediatric Dental and Vision benefits have been implemented for those up to the age of 19.

What is covered under the Student Health 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. Preventive Care Services are available to cover routine physicals and examinations, routine screenings, routine GYN examinations, and most immunizations with no cost sharing for a student when services are received by In-Network Providers. 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%. Please refer to the plan brochure available at www.gallagherstudent.com/BostonConservatory by clicking on ‘My Benefits and Plan Information’ for complete details about coverage, limitations, and exclusions.

How much does the plan cost?

Annual Period: 09/01/2014 -08/31/2015

Enrollment/Waiver Deadline August 7, 2014
Undergraduate Student
$1,596
Graduate Student
$1,945
Spouse/Domestic Partner*
$3,942
Each Child*
$2,603
*A nominal, non-refundable processing fee applies

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

Yes, pre-existing conditions are covered immediately under the 2014-2015 Student Health Insurance Plan.

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

A deductible is the amount for which you are responsible before payment is madeby 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 person, per policy year deductible that applies to services received from an In-Network Providerand a $200 per person, per policy year deductible that applies to services received from an Out-of-Network 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 in MA, NH and ME and the UnitedHealthcare Options PPO Network nationally, because providers participating in these networks have agreed to accept a predetermined negotiated amount, or Preferred Allowance, as payment for their services. Go to www.gallagherstudent.com/BostonConservatory and click on ‘Find a Doctor’ to locate participating In-Network Providers.

Do I get an ID card?

Yes, ID cards are available online. They may be printed from a computer or viewed on your smart phone.

How do I get my prescriptions filled?

Prescriptions can be filled at a United Healthcare Pharmacy Network participating pharmacy. To find a list of participating pharmacies near you, visit www.gallagherstudent.com/BostonConservatory and click on ‘Pharmacy Program’. At participating pharmacies, you will pay a $15 copayment for a 30-day supply of a Tier-1 drug, a $30 copayment for a 30-day supply of a Tier-2 drug, and a $50 copayment for a 30-day supply of a Tier-3 drug. Prescriptions are also available through a Mail Service Program. Through the Mail Service Program you will pay 2.5xthe cost of a 30-day supply for a 90-day supply of your prescription drug. Click on ‘Pharmacy Program’ at www.gallagherstudent.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. Students who are studying or traveling abroad and need more than a 30-day supply of their prescription may fill out a Prescription Override form by visiting www.gallagherstudent.com/BostonConservatory and selecting ‘Pharmacy Program’, then ‘Pharmacy Override Form’. 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.

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

Yes, the Student Health 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 Evacuation and Travel Assistance Services through FrontierMEDEX, the 24-hour worldwide assistance service. All services must be arranged for in advance and provided by FrontierMEDEX. Any services not arranged by FrontierMEDEX will not be considered for payment. When studying or traveling abroad, keep your Student Health Insurance Plan ID 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 school name are on the bill.

Eligibility, Enrollment & Waiving

Who is eligible for the plan?

Massachusetts law mandates that all full-time and three-quarter time students have health insurance coverage; therefore,students are automatically enrolled in and billed for the Student Health Insurance Plan which meets the requirements of the Commonwealth of Massachusetts.

Can I enroll my eligible dependents?

Yes, you can enroll your eligible dependent(s) at the same time as your own initial plan enrollment by following the steps described in the ‘How do I...’ section of this document. Dependent coverage must be purchased for the same time period as the student’speriod 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 also 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. If dependent enrollment meets one of these qualifying events, the Dependent Enrollment Form, supporting documentation, and payment must be received by Gallagher Student Health & Special Risk within 31 days of the qualifying event. Forms received more than 31 days after the qualifying event will not be processed. Once a dependent is enrolled, coverage cannot be terminated unless the student loses eligibility. Students can 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.

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 yourparent(s). However, before you do so, you should fully compare the employer plan against this Student Health Insurance 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 Health 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 Health Insurance Plan, especially if your parents’ employer plan is considered a ‘high deductible’ plan.

What is considered ‘comparable coverage’?

Determining comparable coverage requires comparison of cost-sharing levels (deductibles and coinsurance) and access to In-Network Providers. The level of benefits should meet or exceed the benefits provided through the Student Health Insurance Plan. Coverage is considered comparable if it provides students with access to a range of services in and around the area where they attend school. Services include, but are not limited to, preventive and primary care, emergency care, surgical care, inpatient and outpatient hospitalization benefits, lab work, diagnostic x-rays, physical therapy and chiropractic care, prescriptions, and mental health and substance abuse treatment. Also, consider the amount of your current plan’s deductible and In-and Out-of-Network coinsurance to avoid high out-of-pocket costs. Students should be able to seek these services from providers who are considered In-Network or Preferred. If your current plan is an HMO, it is very likely that coverage is limited, or not available, outsideof the HMO’s service area. Plans that only provide emergency services in the campus area are not considered comparable.

Can I waive theStudent Health Insurance Plan with any of the insurance plans offered throughmy State Marketplace?

Students are eligible to enroll in an insurance plan offered through the Marketplace in their home State. If you are a Massachusetts resident, you can waive your Student Health Insurance Plan with a plan purchased through the MA Health Connector. Please review these plans carefully. Many of these plans will have a deductible greater than the deductibles on the Student Health Insurance Plan which will increase your out-of-pocket costs. Also look at the In-Network and Out-of-Network Provider coverage levels and be sure that In-Network Providers are located near yourcampus. If you are not a Massachusetts resident, there is good possibility that a plan purchased through your home State’s Marketplace will not provide adequate coverage. Please review this carefully.

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, mental health, etc.) on-and off-campus? Does your plan have doctors and hospitalsnear campus? 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? Please Note: International students are enrolled on a mandatory basis and cannot waive the Student Health insurance Plan unless they provide proof of comparable coverage from a U.S.basedinsurance carrier.

Students who do not complete a decision form by the published deadline will be automatically enrolled in and billed for the Student Health Insurance Plan. It is recommended that all students submit an online decision form, whether enrolling or waiving.

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 ifseeking 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 address provided in the Important Contact Information section of this document.

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 notification 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 promptly. You may also receive a request 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?

TheStudent Health Insurance Plan has a coordination of benefits provision. This means your plan with Gallagher Student Health & Special Risk 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 the brochure for details.

Plan Enhancements

What enhancements are available under this plan?

Exclusively from Gallagher Student Health & Special Risk, enrolled students have access to a menu of products at no additional cost. More information is available by visiting www.gallagherstudent.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 period for which you have purchased coverage. There is no option to continue coverage after the policy terminates.

Are there any additional insurance products available?

Please visit www.gallagherstudent.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.

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