Under Massachusetts State Law, a student is required to participate in a “qualifying student health insurance program” or in a health insurance program with comparable coverage (your health insurance MUST meet the minimum standards - "Massachusetts Universal Health Care Standards"). Please compare the minimum standards with your own personal policy. This law pertains to undergraduate students who are enrolled for nine credits or more and graduate students who are enrolled for seven credits or more.
Mandatory Health Insurance Information
Visiting www.gallagherstudent.com/wne will take you to the Gallagher Student Health & Special Risk web site for completion of waiver or enrollment form. All waivers or enrollments must be completed online.
The following summary has been compiled to assist in determining whether benefits provided under an existing health insurance program are comparable to those specified by the Commonwealth of Massachusetts as qualifying student health insurance program.
The following benefits must be included. If any benefit is not available, the Commonwealth of Massachusetts requires participation in a qualifying student health plan.
A. Health benefits are to be available to the student throughout the academic year and be reasonably comprehensive in terms of hospital and physician services. NOTE: Some HMO and PPO policies restrict health care to a particular service area, which would make benefits unavailable while attending school.
B. Services covered are readily accessible while the student attends college and should also be available if the student is away from campus for any reason.
C. Inpatient hospitalization:
1. Room & Board coverage of expenses actually incurred in semi-private or intensive care unit at 80% of covered charges for each illness or accident;
2. 80% of actual expenses for hospital services such as x-ray, lab tests, use of operating room etc.;
3. 80% of physician fees excluding surgical fees;
4. Surgical coverage at 80% of actual expenses up to a maximum of $5,000;
5. At least 30% of surgical cost for services of anesthetist/assistant surgeon;
D. Ambulance coverage of at least $125 per illness or injury - may be subject to a $25 deductible;
E. Outpatient Coverage:
1. 80% of actual expenses for physician, emergency room, lab, radiology, hospital outpatient to at least $1,500; a co-payment or deductible may be applied for each visit in accord with the schedule which follows:
Physician office visit $25
Hospital Outpatient $50
Hospital ER $100
F. High Cost Procedures:
For outpatient procedures costing over $200, coverage of 80% up to at least $2,000 per illness or injury;
G. Aggregate indemnity to be paid for all benefits must be at least $25,000;
H. Pregnancy or conditions thereof are to be treated as any other illness or injury within the benefit levels provided; the same holds true for mental illness, substance abuse with minimum benefits provided according to state law;
I. Services delivered in accordance with the healing practices of Christian Science shall be included;
J. There shall be no exclusion of benefits for suicide, attempted suicide, or self-inflicted injury.
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