Waiver Appeal Policy

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 (See http://wheaton.edu/Student-Life/Student-Care/Student-Health-Insurance ).

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 from Gallagher Koster (insurance provider).

APPEALS

Appeals regarding the waiver application process or decision should first be made to Gallagher Koster. During open enrollment the official denial from Gallagher Koster is simply the screen shot showing that you have answered a question within the waiver incorrectly and have been removed from the main waiver screen. This rejection may be used as the official denial from Gallagher Koster. This screen shot with an explanation of what statement you were not able to answer should be placed on the official waiver appeal paper work (SHIP-Appeal-Form).

There is customer service information on their website if you should have any questions. After the official deadline the waiver is removed the Gallagher Koster website and an appeal to waive will replace it. You must complete this appeal that is found on the Gallagher Koster site which will be available beginning September 4th. Should the appeal be denied by Gallagher Koster , the company will send a formal rejection of appeal letter to you. If you so desire, you may complete the waiver appeal form within 3 business days and submit it to the e-mail address described below for further review. You will be notified of the final decision via e-mail and post.

Upon receiving a rejected appeal from Gallagher Koster, the student has the option of resubmitting their appeal to Student Health Services for resolution by the Student Health Insurance Committee (SHIRC). 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.
• 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 and Student Health Services will request a refund from the contracted claims administrator.

Appeal decisions are final and with no further review.  

Application for appeal review will be available on the Gallagher Koster Website after January 31st. The waiver appeal process must be completed in this order:

1. If you have been denied within the waiver process prior to the deadline, please capture the screen shot and send it to Health.Insurance@wheaton.edu with the completed Waiver Application Form. 
2. 2) If you have missed the deadline waiver date, you can submit a petition to waive form to Gallagher Koster. If you are denied, you may submit this denial and the completed waiver appeal form to Wheaton College via the Health.Insurance@wheaton.edu e-mail for further review. Please review the full policy for exact instructions of this procedure.