Waiver Appeal Policy

Effective: July 1, 2013

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Wheaton College practices a “hard waiver” insurance program. This simply means that every year eligible students are required to prove that they have adequate health insurance coverage. Eligibility requirements are stated in detail on the SHI website.

Students who believe they have health insurance comparable to the guidelines set out by Wheaton College and wish to waive the purchase of the College plan must complete an on-line waiver that shows proof of comparable coverage. The online waiver must be completed prior to the prescribed open enrollment deadline for the semester they are entering. Upon completing the waiver correctly, the student will receive a confirmation number via email from Gallagher Koster (insurance provider). This confirmation number does not show approval of the waiver, but only receipt.

If you would like to know more about the health insurance requirement, you can read Health Insurance Requirements or email Health.Insurance@wheaton.edu. Please allow 48-72 hours for a reply.

APPEALS

A. Appeals regarding the waiver application process or decision should first be made to Gallagher Student Health & Special Risk.

  1. If you do not meet with requirements of Wheaton College, the waiver will not be able to be completed.  You should take a screen shot of the denial notice and send this with the appeal form to Gallagher Student Health.
  2. If you have missed the deadline for the waiver, you must complete the “Petition to Waive” form on the Gallagher Student Health website and send it into their office for review.

There is customer service information on their website. Should the appeal be denied by Gallagher Student Health, the company will send a formal rejection of the appeal letter or Petition to Waive to you and to Health.Insurance@wheaton.edu

B. Upon receiving a rejected appeal from Gallagher Student Health, the student has the option of resubmitting their appeal to Student Health Services for resolution by the Student Health Insurance Committee (SHIRC) within 3 business days of the Gallagher Student Health decision. You may submit the Waiver Appeal Form to Health.Insurance@wheaton.edu. The decision to approve or deny the appeal will be based on the following conditions:

  • An extenuating circumstance beyond the student’s control made it impossible for the student to comply with the enrollment deadline.
  • An undue hardship (beyond simple inconvenience or cost) would result from a strict application or interpretation of comparable coverage.
  • Appeals for a missed deadline will generally not be granted as a significant grace period is already in place by allowing a lengthy open enrollment. Students are sent an email and a post card at minimum as a reminder of the deadline.
  • Appeals are accepted only for fees assessed in a current semester. Appeals cannot be filed for fees from previous semesters.
  • Appeals must be submitted within two weeks of notification of a denied waiver.
  • Appeals that are accepted may be subject to a $50.00 late fee for processing.
  • All appeals and support documents must be submitted in writing.

 

Student Health Services (SHS) will provide to the appeals committee:

  • The original waiver submitted if applicable.
  • The reason for the denial of the original waiver
  • The Petition to Appeal SHIP fee as submitted by the student. Letter of Verification identifying your insurance carrier, active coverage dates and any supporting documentation. The student must request a completed Letter of Verification must from his or her insurance representative and turn it in to SHS.
  • Any history of waiver submissions by the student.
  • Data as to whether claims have been filed on the plan by the student
  • Record of any prior communications with the student from SHS and Gallagher Koster.

 

If the appeals committee approves an appeal, the student will be notified.  The student will be required to communicate with Gallagher Koster to update their information with this company.  Student Health Services will communicate the acceptance of the appeal to Gallagher Koster and request for a refund from the contracted claims administrator.

 

Appeal decisions are final and with no further review.

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