What do my benefits include with the Gallagher student health insurance plan?

Modified on Thu, 11 Aug 2022 at 05:36 PM

The Gallagher student health insurance plan is fully compliant with the Affordable Care Act (ACA) and all other federal and state mandates. It pays for a wide range of medical services, including 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. 

 

It covers preventive care services at no cost when you use In-Network providers. This includes routine physicals and examinations, screenings, GYN examinations and most immunizations. 

 

It pays for 80% of your medical fees when you use In-Network providers. This is the advantage to using in-network providers. When you use Out-of-Network providers the coinsurance is less which means your potential out-of-pocket costs are more. You will also be responsible for paying any deductibles and applicable office visit and prescription drug copayments. 

 

• It has a $250 per Insured, per policy year deductible combined for In-Network and Out-of-Network services. 

• Preventive care services, in compliance with the Affordable Care Act, are covered at no cost share to a BCBS participating doctor. 

• Other office visits are paid at 80% coinsurance, after the deductible 

• Prescription drugs are covered for a 30-day supply after a: 

  • $10 copay for a Tier-1 drug 
  • 25 copay for a Tier-2 drug 
  • $45 copay for a Tier-3 drug 

 

In some cases, prescription drugs may have a supply or quantity limit or require your doctor to get a Prior Authorization before you can pick-up your prescription. You can see review your plans’ pharmacy list or formulary by visiting Lesley’s page at www.gallagherstudent.com/lesley.

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