What is a Preferred / In-Network Provider?

A Preferred Provider is a doctor, hospital, or other health care provider that is contracted to participate in a specific network of providers. 

The advantage to using a Preferred Provider is that these providers have agreed to accept a predetermined fee (or “Preferred Allowance”) as payment for their services. When using Preferred Providers, out-of-pocket expenses will be less. 

Note: An insured person should be aware that Preferred Provider hospitals may be staffed with Out-of-Network providers. Receiving services or care from an Out-of-Network provider at a Preferred Provider hospital does not guarantee that all charges will be paid at the Preferred Provider level of benefits.

Click the Find a Doctor box for more information on the specific Preferred Provider Network applicable to your school’s Student Health Insurance Plan.

Network participation is subject to change, so please verify with the provider that they are participating in the network when making an appointment or at the time of service.

Your Insurance plan’s Pharmacy Benefit Manager identifies where you can have your prescriptions filled (“participating pharmacies”), including both national chain and local pharmacies. Additionally, the Pharmacy Benefit Manager will identify what your cost will be for any drug that you may be prescribed (referred to as the plan “formulary” or “Prescription Drug List/PDL”). Your health insurance plan brochure will contain information about costs associated with various tiers of prescription drugs, and then you can the links to your plan’s lookup tools to determine your out-of-pocket cost.

The specific cost or tier-level of a particular drug may change over time, and the formulary governing your insurance plan may change 2-4 times a year.

Mail Order service may also be available, allowing up to 90 days of a maintenance medication to be delivered directly to you.

Click the Pharmacy Program link for more information on the specific Pharmacy Benefit Manager for your School’s Student Health Insurance Plan.

Your Health Insurance ID Card is needed in order for your provider to know who to bill for services you receive. Once Gallagher Student Health has processed your enrollment, you will be able to obtain your ID Card electronically on the website of the insurance company or claims company.

By doing so, you will be able to download, print or email your card information. Click this link for instructions on how to obtain your ID card. 

The Claims Company is the organization that pays insurance claims on behalf of the insurance company. In some cases, the insurance company and the claims company may be the same organization.

We encourage you to create an account with your insurance plan’s claims company directly on their website, as doing so will allow you to view your claims activity and respond electronically to any requests for information that may be necessary.

In most cases, you will not need to submit a claim for reimbursement directly, as your doctor, pharmacy or other healthcare provider will submit claims directly on your behalf, based on the information provided on your health insurance ID Card. However, if you have paid out of pocket for a claim or did not have your insurance card available, you may need to complete a claim form and submit for reimbursement of amounts you have paid directly.

Click the Claims Company link for more information on the Claims Company that is servicing your School’s Student Health Insurance Plan and important instructions that you may need.

Your Insurance plan’s Pharmacy Benefit Manager identifies where you can have your prescriptions filled (“participating pharmacies”), including both national chain and local pharmacies. Additionally, the Pharmacy Benefit Manager will identify what your cost will be for any drug that you may be prescribed (referred to as the plan “formulary” or “Prescription Drug List/PDL”). Your health insurance plan brochure will contain information about costs associated with various tiers of prescription drugs, and then you can the links to your plan’s lookup tools to determine your out-of-pocket cost.

The specific cost or tier-level of a particular drug may change over time, and the formulary governing your insurance plan may change 2-4 times a year.

Mail Order service may also be available, allowing up to 90 days of a maintenance medication to be delivered directly to you.

Click the Pharmacy Program link for more information on the specific Pharmacy Benefit Manager for your School’s Student Health Insurance Plan.

The Claims Company is the organization that pays insurance claims on behalf of the insurance company. In some cases, the insurance company and the claims company may be the same organization.

We encourage you to create an account with your insurance plan’s claims company directly on their website, as doing so will allow you to view your claims activity and respond electronically to any requests for information that may be necessary.

In most cases, you will not need to submit a claim for reimbursement directly, as your doctor, pharmacy or other healthcare provider will submit claims directly on your behalf, based on the information provided on your health insurance ID Card. However, if you have paid out of pocket for a claim or did not have your insurance card available, you may need to complete a claim form and submit for reimbursement of amounts you have paid directly.

Click the Claims Company link for more information on the Claims Company that is servicing your School’s Student Health Insurance Plan and important instructions that you may need.