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Provider WellFleet/CIGNA
Policy Year August 1, 2022 through July 31, 2023
Plan Features
  • Fully compliant with the Affordable Care Act (ACA)
  • Access to In Network providers whether at home,
    campus, or throughout the country through the CIGNA
    PPO network.
  • Unlimited plan maximum benefit
  • $100 Individual/$200 Family Deductible In Network
  • Coverage at 80% In-Network & 60% Out-of-Network
  • In-Network Physician’s Office visits covered at 80% –
    no copay
  • In-Network Preventive care services with no
    deductibles, copays or coinsurance
  • Prescription drug coverage with low copays via
    WellFleet RX
  • Pediatric Dental & Vision coverage up to age 19
  • Worldwide assistance services through Travel Guard
  • A voluntary Dental Plan and a Voluntary Vision Plan is
    available to all students
Comprehensive Coverage for
  • Emergency Room visits
  • Inpatient/Outpatient hospitalization
  • Physicians visits
  • Lab work and tests
  • Preventive and Chronic Care Treatment
  • Unanticipated sickness and injury
  • Access to wellness information
  • Ability to add spouses/domestic partners and
    dependents
RATES FOR
2022-2023 		Annual *Fall Spring/Summer Summer
Coverage Dates 8/1/2022 –
7/31/2023		 8/1/2022 –
12/31/2022		 1/1/2023 –
7/31/2023		 5/1/2023 –
7/31/2023
Student $3,873 $1,624 $2,249 $976
Spouse/Partner $3,873 $1,624 $2,249 $976
Each Child+ $3,873 $1,624 $2,249 $976
All Children+ $7,746 $3,248 $4,498 $1,952
*Fall only coverage is only available to students in one-semester programs at the University. Students who graduate in December must contact Contact before November 19, 2022 for a refund of the Spring/Summer portion once we verify your graduation.
Personal Health Insurance Required Optional
Full Time Students (Graduate, Undergraduate, English Language Institute) ✔
Part Time Students ✔
Students of Model Secondary School for the Deaf ✔

Important Information Due to the worldwide pandemic of COVID-19, Gallaudet is no longer accepting Medicaid outside of the D.C., Maryland or Virginia.
Accepted for Waiver Family/Parental Policy Medicare Policy Individual Policy
Not Accepted for Waiver Medicaid plans from outside D.C., Maryland or Virginia are not accepted.
Out of area plans will not cover medical services outside of your home
state.
Action Required If you have other insurance, it is essential that you waive the Gallaudet
plan to avoid being charged the Annual Health Insurance fee. Even if you
received a waiver last year, you are still required to do it again this year if
you do not want to purchase the Gallaudet plan. Failure to provide
comparable insurance information on the waiver form will result in
automatic enrollment to the University plan for the entire policy year and
will be added to your student account.
DEADLINES Fall Semester Spring Semester
Enroll or Waive by August 29, 2022 January 17, 2023

ONLINE WAIVER/ENROLLMENT PROCESS

To complete the Online Health Insurance Decision form for the 2022-2023 policy
year:

  1. Go to www.gallagherstudent.com/gallaudet
  2. Click on “Account Home” on the left column under My Account, you will be redirected for
    authentication.
  3. Use your Gallaudet email and password to log in.
  4. Click on ‘Purchase Health Insurance/Waive Health Insurance’.
  5. Click the ‘I want to Purchase or I want to Waive’ button. If you want to waive, please have
    your health insurance card available as you’ll need information to complete the waiver
    information section
  6. Follow the instructions to complete the form.
  7. Print or write down your reference number. Receipt of this number confirms acceptance of your form.

*If a waiver form is not submitted by the deadline, you will remain enrolled in and billed for the Student Health Insurance Plan for the entire policy year.

Questions?

You can contact your University representative, Sherri Necessary or Gallagher Student Health & Special Risk at 1-844-598-1939 or by visiting the Customer Service contact page at gallagherstudent.com/Gallaudet.

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