If I lose coverage under another insurance policy, can I enroll in the school’s plan?
Yes, if you waived the Student Health Insurance Plan and then lose coverage under that plan due to a qualifying event (see specific question below) you may submit a Petition to Add form. Make sure you read the form carefully as it contains very specific information on the Petition to Add process, including required documentation to show proof of loss. We will need to confirm your plan eligibility with your school before processing your request. Petition to Add forms are processed within 5-7 business days after confirming plan eligibility with your school.

Am I eligible to Petition to Add?
You need to meet the definition of your plan’s eligibility statement which you can find in your school’s FAQ or in the plan brochure. To access these documents, click the “My Benefits and Plan Information” located on the left-hand side of this homepage.

Students who enroll on a voluntary basis are not eligible to petition to add and will need to wait until the enrollment period for the next plan coverage period in order to purchase coverage.

What is considered a qualifying event?

• Reaching the age limit of another health insurance plan (Example: Turning Age 26)
• Loss of health insurance through a marriage or divorce
• Involuntary loss of coverage through my parents health insurance plan
• Involuntary loss of coverage through my employer

What other information do I need to submit with the Petition to Add form?
You must include documentation form your insurance company (for example a letter on the company's letterhead or Conformation of Coverage form) confirming your loss of coverage and indicating your last date of coverage. The following are supporting documentation requirements:

• Must have the student's full name
• Must have the last date of your coverage (termination date)
• COBRA eligibility letters can only be accepted if the letter states the student's full name and termination date. A COBRA letter is not an official termination letter. COBRA eligibility letters are sent to you prior to losing coverage.

Also please note the following:

• Supporting documents need to be in pdf format; they cannot be in Word doc or email for authenticity reason.
• Screenshots will not be accepted.

Will I have a break in coverage?
You will not have a break in coverage if the Petition to Add form and applicable documents are received within 30 days of your qualifying event. If the Petition to Add form and required documentation are not received within 30 days of your qualifying event, the effective date will be the date this form and applicable documentation are received at Gallagher Student Health.

Will the premium be pro-rated?
Yes, the premium you pay will be pro-rated on a monthly basis determined by the date of your Qualifying Event.

Coverage can only be added if there is a Qualifying Event (QE). A QE is defined as:

• Reaching the age limit of another health insurance;
• Loss of health insurance through a marriage or divorce; or
• Involuntary loss of coverage from another health insurance.

Notice to Students: I understand this Petition is subject to the approval of Gallagher Student Health & Special Risk (GSH) and the payment of any applicable premium. I also understand that GSH will confirm my eligibility with my school before my petition request is processed. If it is discovered that I do not meet the eligibility requirements, this form will not be processed.
Premium is calculated on a monthly basis. The effective date of coverage will determine premium due. Once your petition has been processed, coverage cannot be cancelled, except for eligibility reasons or as specifically stated in the policy.
All required documentation must be included. Forms without supporting documentation of the QE will not be processed.
In order to not have a lapse in coverage, this form and supporting documentation must be received by GSH within 30 days of the QE. If this form and supporting documentation are not received within 30 days, the effective date will be the date this form is received by GSH.
By signing below, the student acknowledges the following: 1) I have carefully read the brochure and elect to enroll as indicated on this form. 2) I meet the eligibility requirements for this coverage as described in the plan materials.