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Insurance Plan Benefits

What changes have been made to the plan for the 2013-2014 Policy Year?

  • The Student Health Insurance Plan is compliant with the second phase of Federal Health Care Reform.
  • The Plan maximum has been increased from $100,000 per policy year to $500,000 per policy year.
  • Graduate students are no longer enrolled on a hard waiver basis.

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.
  • The maximum benefit allowed per policy year is $500,000 (for all conditions) however there are several additional expense limitations within the plan. As a result students should refer to their brochure schedule for details.
  • Services provided by a participating network provider are generally covered at 80%, while services provided by a non-network provider are generally covered at 60%.
  • Please refer to the plan brochure available at www.gallagherkoster.com/Elmhurst by clicking on ‘My Benefits and Plan Information’ for complete details about coverage, limitations, and exclusions.

How much does the plan cost?

Full-Time Undergraduate Students:
Annual (8/1/13-7/31/14) $1092;
Spring (2/1/14-7/31/14) $546

Graduate Students & Part-Time Undergraduate Students:
Annual (8/1/13-7/31/14) $1761;
Spring (2/1/14-7/31/14) $879

How do I get my prescriptions filled?

  • Prescriptions can be filled at any Express Scripts participating pharmacy. To find a list of participating pharmacies near you, visit www.gallagherkoster.com/Elmhurst and click on ‘Pharmacy Program’.
  • At designated Express Scripts pharmacies you will pay a $15 copayment for a 30-day supply of a generic prescription, a $30 copayment for a 30-day supply of a preferred brand name prescription and a $60 copayment for a 30-day supply of a non-preferred brand name prescription drug up to the $500,000 maximum benefit.
  • Prescriptions are also available through a Mail Service Program. Through the Mail Service Program you will pay 2 times the cost of a 30-day supply for a 90-day supply of your prescription drug. Click on ‘Pharmacy Program’ at www.gallagherkoster.com/Elmhurst 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 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.gallagherkoster.com/Elmhurst and selecting ‘Pharmacy Program’, then ‘Pharmacy Override Form’.

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

If you are under the age of 19, you are immediately covered for pre-existing conditions.

If you are 19 or older, 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 Elmhurst College Student Health 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, or you will not be covered for any pre-existing 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 Health Insurance Plan, but there are many benefits to first seeking care or advice from the Elmhurst College Wellness Center. Students should be aware that on-campus Health Services are available to them. Your school’s Health Services website is located at www.elmhurst.edu/wellness.

Do I get an ID Card?

Yes, ID Cards are available online and may be printed from our website or viewed on a smart phone. They are also mailed to the address that your school has on file for you.

How do I print an ID Card online?

  1. Go to www.gallagherkoster.com/Elmhurst.
  2. Log in using your email address and student ID number.
  3. 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 Elmhurst College 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 Expense Benefits and Travel Assistance Services through Europ Assist, the 24-hour worldwide assistance service. All services must be arranged for in advance and provided by Europ Assist. Any services not arranged by Europ Assist 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 Elmhurst College’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 policy year deductible that applies to services received from a Network Provider. There is also a $50 per Policy Year deductible that applies to services received from a Non-Network Provider.

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