The 23/24 waiver form is no longer available. The 24/25 waiver form will be available early June.
Student Health Plan
- Waiver Form
- Enrollment Form
- Qualifying Event Enrollment Form
-
CareConnect –
Behavioral Health Hotline - Provider Search
- Claim Form
- Insurance ID Card
- Insurance Mobile App
Optional Plans
Additional Information
PLAN CHANGES FOR THE 2016-2017 POLICY YEAR:
UNDERWRITER:
The underwriter for the plan has changed from Nationwide Life Insurance Company to National Guardian Life Insurance Company. Claims are still submitted to Cigna and, subsequently, processed by Consolidated Health Plans (CHP).
DEDUCTIBLE:
There is now only one in-network deductible of $50 and one out-of-network deductible of $50 per policy year, regardless of how many conditions are treated. If the deductible is applicable for a medical service, it can be waived by receiving a referral from the Health and Wellness Center.
REFERRAL:
A referral from the Health and Wellness Center is not required for the 2016-17 policy year. A Health and Wellness Center referral may be used to waive the deductible, if applicable, for a medical service.
COINSURANCE:
Unless stated otherwise in the brochure, the plan will pay at 95% of the Preferred Allowance for in-network services and 85% of Reasonable & Customary Charges for out-of-network services.
OUT-OF-POCKET MAXIMUM:
The out-of-pocket maximum for eligible expenses in-network is $1,500. There is no maximum for out-of-network services.
Lehigh University Qualifying Life Event
Students who waived the Student Health Insurance Plan (SHIP) and recently lost their other coverage or moved to the US can contact the Lehigh Bursar Office at bursar@lehigh.edu to request the qualifying event enrollment form (include your LIN in your email). Once the qualifying event enrollment form has been completed, eligibility will be confirmed, and the insurance charge will be added to the student's account. Once payment has been made to the Lehigh Bursar Office, enrollment will be sent to Wellfleet for processing. If the loss of coverage occurs between 8/15 and 12/31, payment due is the annual premium. If the loss of coverage occurs between 1/1 and 8/14, payment due is the spring premium. The deadline to complete the enrollment form is 60 days from the qualifying life event.