Q: Is there any dental or eye care coverage with the VLS Gallagher plans?
A: Generally speaking, there is no dental coverage offered under the VLS Gallagher plan, except accidental injury to natural teeth that requires hospital treatment. A discount vision plan is available through EyeMed Vision Care. A Basix Dental Savings plan is available through Gallagher. The Dental Savings Program is not dental insurance. Basix contracts with dentists that agree to charge a reduced fee to students covered under your Gallagher Student plan. Both the EyeMed Vision Care & Basix Dental Savings plan must be purchased by the Student, separate from the health insurance, via the insurance portal.
Q: What is meant by “out of pocket maximums”?
A: This refers to the total amount of money the subscriber will have to pay out of pocket towards their healthcare costs (not including the health insurance coverage premium). This maximum includes the deductible amount. For example:
A student that has single coverage under the Plan ends up with a hospital or outpatient surgery bill of $ 10,000 (using the participating provider network). The out-of-pocket costs for the student would be as follows:
| STUDENT PAYS | BLUE CROSS PAYS |
|---|---|
| A. $750 Deductible | A. Nothing |
| B. The co-insurance will start and the student will be responsible for 20% of the remainder of the bill until the out-of-pocket maximum is reached (which is at the $5,500 point). | B. The co-insurance will start and NGL is responsible for 80% of the remainder of the bill until the out-of-pocket maximum is reached. |
| C. The student’s final bill will be $6,250, which is comprised of the $750 deductible and the rest of the out-of-pocket maximum due to reaching the maximum amount of $5,500. | C. The final bill paid by NGL to the healthcare provider is $8,500 ($10,000 minus the $6,250 provided by the student). |
Q: What is meant by “participating provider network”?
A: The participating provider network means as long as you have services provided by a physician/doctor or hospital that participates with Gallagher Student Health & Special Risk, the provider will submit your claims directly to Gallagher Student Health & Special Risk for payment. They should not ask you to pay any monies at the time of service.
Q: What is meant by “standard allowance”?
A: “Standard allowance” means the amount that Gallagher Student Health & Special Risk negotiates with their participating providers and hospitals. Theses providers agree to accept the standard allowance as payment in full and not bill the subscriber the difference between what they charged (i.e., $100) and the standard allowance (i.e., $80). The difference of $20 is taken off your bill. They can only bill you for the deductible and the 20% co-insurance amount.
Q: What is meant by “routine office visit”?
A: A routine office visit refers to the amount the Doctor charges for the use of his/her office. Routine Office Visits are paid at 100%, after you pay your co-pay. It should be noted that labs and x-rays are not considered part of the routine office visit, and are billed as “hospital care” expense. This means that the cost of the lab or x-ray might apply towards your deductible and/or out-of-pocket maximum.
Q: How am I billed for this insurance?
A: Your annual insurance premium will be billed in two installments. You will receive a charge on your tuition account from Vermont Law School for the first installment (representing six months of coverage) prior to registration day in August. You will receive a charge for the second installment (representing six months of coverage) in January prior to the date that classes resume for the spring semester.
Q: Will you deduct my insurance payment from my student aid?
A: Yes, if your student aid is in excess of the tuition charge, and you have submitted a non-allowable charges form giving us permission to deduct this miscellaneous charge. Otherwise we will look to you for payment.
Q: Do I need to renew this insurance policy every year?
A: Yes. Both enrollment in the Gallagher student insurance plan and waiving of the Gallagher student insurance plan must be renewed at the start of each academic year, regardless of when you enrolled/ waived during the previous academic year.
Q: May I change to a different plan?
A: Yes, however, you may change plans only in August for an effective date of September 1st each year. This time frame is referred to as the open enrollment period.
Q: I’m getting married in October. May I add my spouse to my plan?
A: Yes, you must submit a “Petition to Add” form via the insurance portal. Forms must be submitted within 30 days following your wedding.
Q: Does the VLS Gallagher plan cover domestic partners?
A: Yes, but the partner may be added only during open enrollment period each year (Aug1-Aug 31).
Q: How do I add my newborn to the plan?
A: You must complete a “Petition to Add” Form showing the child’s name and social security within 30 days ( i.e., within 30 days after the birth or adoption of a child).