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Student Medical Insurance

Frequently Asked Questions

Important Numbers & Contact Information

Questions about what's covered, how to access benefits, enrollment concerns, claims advocacy/assistance, or replacement ID cards?

Gallagher Koster
500 Victory Road
Quincy, MA 02171

Phone: (800) 456-3753
E-mail: SmithStudent@gallagherkoster.com

Questions about a specific claim or claims payment?

UnitedHealthcare StudentResources
P.O. Box 809025
Dallas, TX 75380-9025

Phone: (800) 767-0700
E-mail: GKclaims@uhcsr.com

Register for online claims look-up at: www.uhcsr.com, "My Account"

How can I find Preferred Providers in Harvard Pilgrim or UnitedHealthcare?

Go to www.uhcsr.com, under "Find My School's Plan"

Phone: (800) 767-0700

How can I find a participating pharmacy?

UnitedHealthcare Network Pharmacy
www.uhcsr.com, click on "Student Health Insurance & Plans"

Phone: (877) 417-7345

How do I learn more about the Gallagher Koster Complements Programs?

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

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

How do I learn more about Worldwide Assistance Services?

Scholastic Emergency Services
Within the U.S.: (877) 488-9833
Outside the U.S. (609) 452-8570

Enrollment/Eligibility

Who is eligible?

  • Smith College policy requires that all students in a degree program enrolled in at least 25 percent of full-time credits carry health insurance
  • Ada Comstock scholars who are regular employees of the College are not eligible
  • Eligible dependent

How do I enroll?

Students who decide they want to actively enroll in the plan may do so by completing the following steps:

  1. Visit www.gallagherkoster.com/Smith
  2. Click on "Student Waive/Enroll Forms"
  3. Log in using your student email address as your username, and student ID number as your password
  4. Select "I want to Waive/Enroll." Immediately upon submitting your online form you will receive a confirmation number. Please save this number and print a copy of your confirmation for your records.

All students who do not submit an online decision form will be automatically enrolled in the student insurance plan. However, it is recommended for all students to complete and online decision form whether they are enrolling or waiving the plan. Students who do not actively enroll in the health insurance plan but passively enroll in the plan by failing to complete the decision form may experience a delay in their receipt of services.

How do I enroll my eligible dependents?

Students may enroll their eligible dependents online for an additional premium by visiting www.gallagherkoster.com/Smith, selecting "Dependent Enrollment" and completing the form. Dependents must be enrolled by the deadline which is 30 days from the effective date of the policy, or within 31 days of a qualifying event (e.g. marriage, loss of coverage through an employer).

Can I waive the Qualifying Student Health Insurance Program (QSHIP) 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 sometimes limited benefits.

Is there anything I need to know before waiving coverage?

Students can waive coverage by completing the waiver section of the Online Waiver/Enrollment Form. Before waiving you should review your current policy to be sure that it provides comparable coverage:

  • Will your current plan cover medical care beyond emergency services (i.e. doctor's office visits; diagnostic testing, labs & x-rays; and prescription drugs) in the Five College area?
  • Does your plan have a high deductible that must first be met before your plan will pay for services received?
  • Does your health plan have doctors and hospitals in the Five College area?
  • Will your current plan cover inpatient and outpatient mental health and counseling services in the Five College area?
  • If you are able to receive care, will you have to pay upfront and then seek reimbursement?

How do I waive?

After reviewing these considerations, if you wish to waive coverage:

  1. Log onto www.gallagherkoster.com/Smith
  2. Your username will be your Smith College e-mail address. Your password will be your Smith college ID number. If your ID number is less than nine digits, add zeros to the left. Example (123456 becomes 000123456).
  3. Select "I Want to Waive/Enroll." 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.
  4. Immediately upon submitting your online form you will receive a confirmation number. Please save this number and print a copy of your confirmation for your records.
  5. International students can not waive coverage unless they are currently insured by a plan of comparable coverage underwritten by a U.S. based carrier.

Can students with comparable coverage still enroll in the student insurance plan?

Yes. Many parents and students enjoy the peace of mind of having the additional coverage. Some of the benefits of being enrolled in a student plan include:

  • Access to Gallagher Koster Complements, dental and vision savings programs, and CampusFit for a healthy lifestyle initiative.
  • Worldwide Travel Assistance services for students studying abroad, including services for medical evacuation and repatriation.
  • Students who reach the maximum age on their parents’ plan will remain fully insured in the student insurance. There are no limitations based on age.

Insurance Plan Benefits

What changes have been made for 2010-11?

  1. The pre-existing condition limitation has been eliminated
  2. The maximum benefit for Ambulance Services has been removed, unlimited benefit
  3. The outpatient prescription drug maximum benefit has been increased to $2,000 per policy year.
  4. Implement coverage for learning disability evaluation as part of the ADD Testing benefit and increase maximum m benefit to $1,500.
  5. Implement a wellness benefit to cover immunization and associated labs, covered at 80 percent of covered charges up to $400 per policy year.
  6. The insurance company has changed to Harvard Pilgrim Health Care Insurance Company and claims will be paid by UnitedHealthcare StudentResources.
  7. The preferred provider network will be Harvard Pilgrim (in MA, ME and NH) and UnitedHealthcare Options PPO outside of these states. The pharmacy network will be Medco, administered through UnitedHealthcare.

How much does the plan cost?

Visit the insurance page for current rates. Also view the Health Services Current Fees page for lab fees and co-pays.

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 prescriptions.
  • The maximum benefit allowed for each accident or sickness is $100,000.
  • Services provided by a participating network provider are generally covered at 100%, while services provided by a non-network provider are generally covered at 80 percent.
  • There is a $100 per policy year deductible for Preferred Providers and a $200 per policy year deductible for Out-of-Network Providers.
  • Please refer to the plan brochure available at www.gallagherkoster.com/Smith and click on "Brochure and Plan Documents" for complete details about coverage, limitations and exclusions.

How do I get my prescriptions filled?

  • The pharmacy benefit program includes retail chains as well as independent pharmacies through the United Healthcare Network Pharmacy Program. UHC Pharmacies are pharmacies that participate in Medco.
  • At designated UHC pharmacies; you will pay $10 co-payment for a 30-day supply of a Tier-1 drug, and a $25 co-payment for a 30-day supply of a Tier-2 drug, and $45 co-payment for a 30-day supply Tier-3 drug up to the $2,000 per policy year maximum benefit.
  • To help monitor their prescription costs, students will receive notification when they are reaching their maximum benefit and when they have reached the maximum benefit allowed.
  • Outpatient medications for treatment of a Covered Expense are covered prescriptions. If the treatment of a medical condition is limited or excluded, the outpatient prescription is likewise limited or excluded.
  • Click on "Pharmacy Program" at www.gallagherkoster.com/Smith to learn the details of the pharmacy program, including the Mail Service Program. (Students on a maintenance prescription should consider using the Mail Service Program for increased savings.)

What is the Supply Limit Program?

There are specific prescriptions that fall under this program, generally under the categories of anti-depressants and hypnotics or sedatives. The Quantity Level Limits (QLL) program defines the maximum quantity of medication that is covered for one prescription or copayment and the Quantity Duration (QD) program defines the maximum quantity of medication that can be covered in a specified time period.

These drugs are covered but could require additional follow up by your physician if the prescription quantity exceeds and/or duration is shorter than the established supply limits. These supply limits follow manufacturing dosing guidelines, clinical based trials of the drug itself, therapeutic efficiency and other corresponding medical literature.

What if I have a pre-existing condition, am I covered?

Pre-existing conditions are covered immediately as of the effective date of the policy, there is no waiting period.

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

Yes, a referral is required before being able to seek care or treatment from off-campus providers. Please refer to the Referrals page for details about the referral requirement and the exceptions to it.

Do I get an ID Card?

Yes, ID Cards are delivered on campus in your campus mailbox. ID Cards are also online 24–48 hours after receipt of your enrollment information from the college and can be printed per the request of the school or student.

How do I print an ID card online?

  • Go to www.gallagherkoster.com/Smith
  • Login using your existing account information
  • Select "Authorize Account" under Account Information and entered your student ID number along with your date of birth.
  • Once your account has been authorized, select "Account Home" and 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 (SES), the 24-hour worldwide assistance service. All services must be arranged for in advance and provided by On Call International, any services not arranged by SES 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 then will need to seek reimbursement. Covered Expenses will be reimbursed on a Non-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 insure that your name, ID number, address (to receive your reimbursement check), and the college's name are on the bill.

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

Yes this plan has a $100 per person per policy year deductible for network providers and a $200 per person per policy year deductible for non-network providers. Deductible means the amount for which you are responsible before payment is made by the claims company. Once you have paid the $100 or $200 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.

Finding a Provider

Can I go to any doctor or hospital?

Yes. You can go to any provider; however, you can save money by seeing providers that participate in either the Harvard Pilgrim (in MA, ME and NH) or United Healthcare PPO Options (outside of MA, ME and NH and anywhere across the country) Preferred Provider Networks. These providers have agreed to accept a predetermined negotiated amount, or Preferred Allowance for their services.

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

Claims Processing

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

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 you paid for a service and need to be reimbursed, you should send your bill (and proof of payment if seeking reimbursement) to the claims administrator at the following address.

You do not need an additional claims form. Make sure your name, health insurance ID number, and school name are on the bill. Make a copy for your records and send it to the claims administrator.

Claims for services incurred before August 15, 2010, should be sent to:
POMCO/Pioneer Administrative Services
P.O. Box 186
Syracuse, NY 13206
Phone: (866) 653-2542
E-mail: Studentinfo@Pomcogroup.com

Claims for services incurred after August 15, 2010, should be sent to:
United Healthcare StudentResources
PO Box 809025
Dallas, TX 75380-9025
Phone: (800) 767-0700
E-mail: gkclaims@uhcsr.com

How can I check the status of my own claims?

You can go to www.uhcsr.com create a username and password and look up a specific claim or view a list of all claims submitted.

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.

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 you paid for a service and need to be reimbursed, you should send your bill (and proof of payment if seeking reimbursement) to the claims administrator at the following address.

You do not need an additional claims form. Make sure your name, health insurance ID number, and school name are on the bill. Make a copy for your records and send it to the claims administrator:

United Healthcare StudentResources
PO Box 809025
Dallas, TX 75380-9025
Phone: (800) 767-0700
E-mail: GKclaims@uhcsr.com

How will my claims be paid if I have health insurance in addition to the Student Injury and Sickness 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. For the Student Injury and Sickness Insurance Plan, claims will be paid first under this plan and then coordinate with any other health insurance coverage you may have. You will need to provide the claims company with information about your other health insurance company.

Plan Enhancements

What enhancements are available under this plan?

Exclusively from Gallagher Koster, enrolled students have access to Plan Enhancements at no additional cost. Additional information is available by visiting www.gallagherkoster.com/Smith and clicking on "Plan Enhancements."

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 under this plan after the policy terminates?

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

Are there any other additional products available?

The following products are available to you, whether or not you participate in the Student Health Insurance Plan. To learn more about each product and their associated cost, go to www.gallagherkoster.com/Smith and click on "Additional Products."

Student Personal Property Protector PLUS®

Student Personal Property Protector PLUS® is an insurance plan that offers coverage for all types of property including, but not limited to, computer hardware, software, books, clothes and electronics. This comprehensive policy covers damage caused by fire, theft, water, flood, earthquake, riot, accidental damage, and vandalism. College property in the care, custody or control of the student is also covered under this policy.

Plan highlights include:

  • Replacement Cost Coverage
  • Low deductibles: $0, $50 or $100
  • Attractive pricing: $2,000 of coverage for just $50 per year
  • Worldwide protection
  • Full twelve month policy period
  • Thirty day money back guarantee if not satisfied
  • Identity Theft Coverage

Study Abroad

Students, faculty and staff of a United States college or university who participate in a study abroad program may purchase the Study Abroad Accident and Sickness Insurance Program. Visit www.gallagherkoster.com for complete plan details and enrollment information.