FAQs / Contact Us

Q: What are the benefits of the Duke Student Medical Insurance Plan? What does the plan cost?

A: Duke’s Student Medical Insurance Plan (SMIP) is a robust, high quality plan that provides excellent and affordable benefits for our students.  This Affordable Care Act (ACA) compliant plan is designed specifically for students to help support their health and well-being needs while at Duke.  Detailed information on the benefits of the SMIP are available here.  In the Plan Details section of the page, choose the Plan Material dropdown to access this information.  

For students looking to compare the Duke SMIP to other plans, our plan is designated as a Platinum level plan under the ACA rating system.

The annual premium costs for the medical insurance plan are updated each year in mid to late May and published on our website.

Q: When does the medical insurance plan begin?  How long does it last?

A:  The insurance plan year runs from August 1 through July 31 each year.  For students who are incoming to Duke in the spring, your coverage will start January 1 and continue through July 31.

For a small group of programs who are at Duke for a short period of time who are required to have coverage as part of F1/J1 visa at Duke, your coverage dates will align with the dates of your program.  These programs are typically one to four months in length.

Q: Is vision coverage included in the Duke plan?

A: Yes, vision coverage and benefits are included in the student medical plan.  Detailed information on the benefits of the SMIP are available here.  In the Plan Details section of the page, choose the Plan Material dropdown to access this information.  

Q: What are the copays with the medical plan?

A: For in-network services, primary care provider office visit copays are $25 and then 20% coinsurance for all other services.  For in-network specialty office visits, the copay is $35 and then 20% coinsurance for all other services.  The copay for in-network mental health services is $10.

Primary care providers are typically medical providers who specialize in family medicine, internal medicine, or pediatrics.  It may also be helpful to review this brief video on copays, coinsurance, and other key insurance terms.

For more details on copays, coinsurance, and other benefits, please review the detailed information on the benefits of the SMIP, which is available here.  In the Plan Details section of the page, choose the Plan Material dropdown to access this information.  

Q: Besides the copay, is there anything else I will need to pay for my medical care?

A: Yes, the copay is what you will owe at the time of service.  However, coinsurance and deductibles are also healthcare costs that you will be responsible for. Here are some helpful definitions of each of these terms:

• Coinsurance: Your share of the cost of a covered healthcare service. For example, if the plan covers 90% of a service, you would be responsible for 10%. Coinsurance differs between in-network and out-of-network providers. You pay coinsurance plus any deductibles you owe. Your plan’s schedule of benefits will show the coinsurance percentage.
• Copayment/Copay: A flat fee that you must pay upfront for services, generally including office visits, emergency room visits, urgent care, and prescription drugs.
• Deductible: A set amount that you must pay before the plan will pay any coinsurance. Deductibles can be annual or per condition.

It may also be helpful to review this brief video on copays, coinsurance, and other key insurance terms as well as this video that will walk you through how to use your insurance plan.

Q: Is the out-of-pocket maximum cumulative over multiple visits or is it a maximum per visit?

A: The out-of-pocket maximum is cumulative for the plan year.  Your out-of-pocket accumulation starts August 1 with the start of the plan year (or January 1 for students who are incoming in spring) and resets each year in August with the start of the new plan year.

Q: Are prescription medicines covered under the SMIP?

A: Yes, the SMIP covers a wide range of prescription medications.  Coverage for these medications is broken into tiers based on various factors including the type of drug and whether it is generic or brand-name.  You will find that your costs are almost always lower when you are able to get the generic version of the medication instead of the brand-name—just like you would find when you go to the grocery store and have to choose between the generic version of a food vs. the brand name. 

You will have a copay due at the pharmacy when you pick up your medications. Detailed information on the pharmacy tiers, copays, and prescription coverage under the SMIP is available here.   

Q: How can I find out if my medication will be covered by the SMIP and what the cost will be?

A: Update in progress. Check back soon.

Q: What specialists are covered by the SMIP?

A: The SMIP provides coverage for a wide-range of specialists.  For many specialists, a referral may be necessary in order to access their services.  If you are in need of a specialist, we recommend starting with Duke Student Health.  Our team can help you determine if a specialist is needed and help get you connected to that specialist for care.

Q: Does the SMIP provide coverage for in-person and telehealth (virtual) appointments?

A: Yes, both in-person and telehealth or virtual appointments are covered.  More important than the modality of your visit is knowing whether your provider is in-network or out-of-network.  If you are enrolled in the Duke Student Medical or Dental Insurance Plan, you can locate an in-network provider by visiting the Gallagher Student Health Insurance Portal and clicking “Find a Doctor” in the medical or dental section of the page.

If you are enrolled in other private health insurance, visit your health insurance carrier’s website.  You may also find information on locating a provider on the back of your health insurance card.

Q:  Which programs are included in the requirement?

A:  Update in progress. Check back soon.

Q: What happens if I do not opt out within the waiver period?

A: Students who do not take any action before the end of the waiver period will automatically be enrolled in the student medical insurance plan for the plan year.  The premium for the medical insurance plan will be added to your student account.  Students will also not be able to voluntarily enroll in the dental insurance plan after the end of the waiver period.

Q: I am taking all online classes.  Is the requirement determined by course enrollment or academic program?

A: The insurance requirement is based on your academic program.  If you are enrolled in an academic program that is included in the Student Medical Insurance Plan requirement, you will be enrolled in the insurance plan if you do not have an approved waiver on file at the end of the waiver period.  The modality of your courses for a specific term (i.e. in-person, hybrid, virtual) does not change whether this requirement applies to you.

Q: I am a dual degree student.  One of my academic programs falls into the requirement and the other does not.  Does this requirement apply to me?

A:  Yes, this will apply to you based on the program that falls into the requirement.

Q: I am a Robertson Scholar.  How does this requirement apply to me?

A:  You will be required to meet the Duke University insurance requirement during the semesters that you are enrolled at Duke.  When you are enrolled at UNC, you will be required to meet their requirement.  If you enroll in the insurance plan at either university, this should meet the requirement criteria for the other.  If you are submitting a waiver request, there are some differences between the requirements at our institutions, so be sure your plan will meet both sets of requirements.

Q: What are the specific criteria my insurance plan needs to meet in order for my waiver to be approved?

A:  There are several criteria that must be met to receive approval for your waiver request.  This includes:

• You are not a student at Duke on an F1 or J1 visa 
• The plan must be in compliance with the Affordable Care Act (ACA Compliant) 
• The claims administrator of the plan is based in the United States, has a U.S. telephone number and address for submission of claims, and the insurance policy has not been issued outside the U.S. 
• The policy is not a traveling policy. 
• The plan provides unlimited emergency and non-emergency routine health care and mental health benefits in the Durham, NC area, including at Duke Medicine. (In order to meet these criteria, your plan must provide in network benefits at Duke Health facilities for the following services: Primary Care Doctors office visits, Specialty office visits, Preventative care office visits, Lab services, X-rays, and imaging) 
• The plan provides inpatient and outpatient mental health care (with at least 30 visits per year) with chemical dependency benefits that are comparable to the coverage provided by the Duke SMIP. 
• The plan provides unlimited coverage for prescription medication. 
• Coverage must be in effect for the length of the SMIP policy year (August 1 - July 31 each year)

Out of state Medicaid and state Children’s Health Insurance Plans, Health Maintenance Organizations (HMOs), and Kaiser Permanente Insurance do not cover non-emergency care in Durham and will not qualify for a waiver.  

Q: How do I waive SHIP coverage?

A: Students* are able to submit waiver requests during the annual enrollment and waiver period.  For the majority of students, this takes place between mid-June and September 15 each year.  For students who are incoming with the spring semester, this takes place between mid-November and January 31. 

To submit your waiver:

• Visit https://www.gallagherstudent.com/duke and follow the log-in instructions
• Once in the portal, you can complete the opt-out process following the prompts on the website.
• Monitor your Duke email for a follow up email from Gallagher regarding approval of your waiver, confirmation of your enrollment, or requests for any follow-up information.
• Once you receive an approval confirmation email, you are all set!  This action is required only once per academic year.

In order to complete the waiver submission, you will need information on your insurance so be sure to have your medical insurance card or plan information in hand.  You will not need to upload documents at the time of the initial submission of your waiver.  If additional information or documentation is needed, you will receive an email notification requesting this information.

Please note, you will not be able to submit a waiver if you have already used the medical insurance plan.  The plan becomes active August 1 each year or January 1 for incoming spring students.  If you have used this insurance plan, you will no longer be eligible to submit a waiver request.

*International students on an F1/J1 visa are required to participate in the student medical insurance plan and are not able to submit a waiver to opt out of the plan.

Q: I submitted a waiver and it was approved, but I want to withdraw that waiver and the waiver deadline hasn’t yet passed.  Can I rescind my waiver?

A: Yes, you are able to rescind your waiver.  However, this must be completed prior to September 15.  To rescind your waiver:

1. Go to https://www.gallagherstudent.com/duke 
2. Follow the login instructions. 
3. Navigate to “Account Details.” 
4. Click “Click Here to Rescind Your Waiver.” 
5. Click “Rescind My Waiver.” 

Please note, once your waiver is rescinded, this action cannot be reversed. You may not edit your form after September 15.  

If you have had a qualifying life event after the waiver /enrollment period has ended, there is a mechanism for enrolling in the student medical insurance plan.  Please review the FAQ related to qualifying life events for more information on this process.

Q: If my insurance situation changes after the waiver period ends and I want to join the Duke plan at that time, can I do so?

A:  If you waive out of the SMIP and then lose your insurance coverage, you can enroll in the plan in many circumstances. Loss of insurance coverage is categorized as a Qualifying Life Event. Other Qualifying Life Events include: 

• Reaching the age limit of another health insurance plan, which typically means turning 26 and no longer qualifying for coverage under a parent or guardian’s plan. 
• Involuntary loss of coverage from another health insurance plan. 

You may also be able to enroll in the plan outside of the enrollment period if one of these qualifying events occurs: 

•   You get married 
•   You have a child, adopt a child, or placed a child for foster care 
•   You get divorced or legally separated and lose insurance coverage as a result 
•   Your dependent enters the country for the first time 
•   Your dependent loses coverage under another insurance plan 

To initiate the process, you must take action within 30 days of the Qualifying Life Event.  To enroll:

1. Go to the Gallagher student insurance portal
2. Follow the login instructions. 
3. Click on “Enroll-Qualifying Life Event.” 
4. Complete the online form and upload the required supporting document, such as the loss of coverage letter from your prior health insurance company showing your name and the last day of coverage. 

Please note: it is important that you read the form carefully as it contains very specific information on the Qualifying Life Event process and you will need to complete the steps exactly as outlined in order to be enrolled in the plan outside of the annual waiver / enrollment period. 

Q: Once I have enrolled in the SMIP, am I able to waive out or cancel later? 

A:  Once you are enrolled in the SMIP and the enrollment / waiver period has ended, you will remain in the plan through the end of the plan year.  You will not have the option to waive out until the next annual enrollment / waiver period.  The only exception to this is for students who enter the armed services who should reach out to our team at shs-insurance@duke.edu for support.

Q: How can I check the status of my waiver request?

A: To check the status of your waiver request, log into the Gallagher student insurance portal.  The waiver review process typically takes 1-3 business days. You will receive communication to your Duke student email to inform you of the approval or denial of your waiver or with guidance on additional information that may be needed.

Q: If I waive the SMIP, can I still use Student Health & CAPS?

A: The student medical plan is an important part of supporting Duke students’ health and well-being.  In addition to the medical plan, Duke offers a wide range of health and wellness services, many of which are already covered in your Student Health Fee.  This includes:

• Duke Student Health – our on campus medical clinic
• Counseling & Psychological Services – offering mental health and psychiatric care
• Nutrition Resources and Information, and
• A vast array of wellness promotion, education and programming, non-clinical case management support, and more.

Students who waive out of the student medical insurance plan continue to have access to these other services through their health fee.  

Q: Do I need to submit a new waiver every year, even if my insurance does not change?

A: Yes, you are required to submit a new waiver request each year you are enrolled at Duke, even if your insurance coverage does not change.  The annual enrollment / waiver period occurs each year starting in mid-June and running through September 15.  Students must have an approved waiver on file by September 15. 

It is important to note for students who may have been incoming during the spring term who completed their first waiver / enrollment between mid-November and January 31 that they will need to take action during the next annual waiver / enrollment period in June through September as well.  

Students who do not have an approved waiver on file at the end of the waiver / enrollment period will be enrolled in the student medical insurance plan and will be responsible for the cost of the annual insurance premium.  

International students on an F1/J1 visa are required to participate in the student medical insurance plan and are not able to submit a waiver to opt out of the plan.

Q: I am starting at Duke in the spring semester.  When is my enrollment / waiver period?

A: Students who are starting at Duke during the spring semester or who were not enrolled during the fall and are returning during the spring semester will need to complete the enrollment / waiver process in the spring.  The enrollment and waiver period typically begins mid-November and goes through January 31.  Students who do not have an approved waiver on file by January 31 will remain enrolled in the plan and be responsible for the prorated amount of the insurance premium for January 1 - July 31 coverage.

It is important to note for students who may have been incoming during the spring term who completed their first waiver / enrollment between mid-November and January 31 that they will need to take action during the next annual waiver / enrollment period in June through September as well.  

Q: I am starting at Duke in the summer semester.  When is my enrollment / waiver period?

A: For a limited number of students at Duke, their academic year starts in July.  You will be required to participate in the fall enrollment / waiver period that typically opens in June and runs through September.  You may have the option to enroll in the insurance plan voluntarily in July.  Please consult with your program coordinator or the shs-insurance@duke.edu team for support.

Q: My waiver was denied, what can I do?

A: If your waiver is not approved, you will receive an email to your Duke email address that outlines the denial reason(s).  This notification will also specify if additional information is required in order to make a determination regarding your waiver submission.  

Students who do not have an approved waiver on file at the end of the waiver / enrollment period will be enrolled in the student medical insurance plan and will be responsible for the cost of the annual insurance premium.  

International students on an F1/J1 visa are required to participate in the student medical insurance plan and are not able to submit a waiver to opt out of the plan.

Q: I am having issues submitting my waiver or with the enrollment process?

A: Thank you for letting us know. It is our goal to make this process as easy and straightforward as possible.  Here are some of the most common issues or errors that occur during the enrollment / waiver process:

• Using the wrong ID number.  Duke students have two ID numbers–their student ID and their Duke Unique ID.  We use your Unique ID for things related to the insurance requirement.
• Unable to log in when using your Duke Unique ID:
  • Double check the ID number and date of birth entered, both must match our system in order to create an account
  • Recently registered students may take time to show up on a roster.
    • If the Duke unique ID number and Date of Birth are correct and you have recently registered, wait one week and try again.
    • If you have registered more than one week ago and are still having issues, contact the Gallagher team at 866-931-5275.
• Not having the necessary information with you when submitting your waiver.  Students should have their health insurance ID card with them when completing the waiver.
• When reaching out for assistance, be sure to include yourDuke Unique ID and full name so our teams can quickly assist you.

Q: How will I be notified of the Enrollment/Waiver process?

A:  You will receive email notifications from Duke Student Health Insurance and Gallagher Student Health that outlines the enrollment dates, along with instructions on how to enroll in or waive Student Medical Insurance, Dental Insurance, and how to enroll dependents. 

If you remain on either the medical or dental insurance plan, you will receive information when the plan has become active that includes details on your plan information, ID number, how to access your insurance cards, and other important details.   

Gallagher will also send email notifications pertaining to your waiver submission and approval or denial, if applicable. 

All email communications will be sent to your Duke student email account.

Q: When will the charge for the premium be added to my student account and how do I pay?

A: The charge for the annual student medical insurance premium as well as the dental insurance premium, if applicable, will be added to your student account in mid to late June.  The charge will be for the full year’s insurance premium.    

The bills for fall semester are typically due August 1st, but students should refer to the deadlines listed on the Bursar’s Office website for most up-to-date dates and deadlines.  The Bursar’s Office website also provides detailed guidance on how to make payments on your student account.

For students who were not enrolled at Duke in the fall term and are either incoming or returning in the spring, the charge for the spring term’s insurance premium, which covers January 1 - July 31, will be added to your student account in mid-November.  

Q: I submitted my waiver and it was approved. When will the charge be removed from my student account?

A: Please allow 7-10 business days for your Bursar account to reflect the student insurance premium credit.  

It is important to note that you will not be able to submit a waiver if you have already used the medical insurance plan.  The plan becomes active August 1 each year or January 1 for incoming spring students.  If you have used this insurance plan, you will no longer be eligible to submit a waiver request and the charge will remain on your student account.

Q: What if I am unable to pay the premium at one time?

A: Duke offers the option to make monthly payment on student account balances.  For detailed guidance on payment plans that are available for students and parents or guardians, please see the Duke University Bursar’s Office website.  Answers to many commonly asked questions related to payment options, student account balances, and how to make payments can be found on their website as well.  For any questions that are not answered on their website, students can connect with the Bursar’s Office team at bursar@duke.edu.

Q:  I can’t log on to the Gallagher portal.  Where do I go for help?

A: Students who are having challenges logging onto the Gallagher Student Insurance Portal should connect with the Gallagher Support team to assist with this error.  Students can connect by using the Contact Us form on the Help Center website or by calling 866-931-5275.

For new students, you will not be able to begin accessing the portal until mid to late June after you have received the email from Duke Student Health Insurance Support Team announcing the updates for the new plan year and the opening date for the student insurance portal.

Only students who are required to meet the student medical insurance plan requirement will be able to access this portal.

If you are unsure if the requirement applies to you, please reach out to shs-insurance@duke.edu for assistance or call us at 919-684-1000.

Q: I still need help or I have questions specific to my situation.  Who can I talk to?

A: We have a full team available to help provide support and guidance.  For the most expedited support related to your situation, please contact the following:

• For assistance with the Gallagher student insurance portal, benefits questions, or claims assistance – connect by using the Contact Us form on the Help Center website or by calling 866-931-5275
• For questions related to student accounts or paying for the insurance premium, contact the Bursar’s Office by emailing bursar@duke.edu or 919-684-3531
• For all other inquiries, connect with the Student Health Insurance Support Team at shs-insurance@duke.edu or call us at 919-684-1000.

Q: Continuation of coverage after graduation

A: Congratulations on your graduation!  For students graduating in May, you will remain enrolled in the insurance plan until the end of the plan year on July 31.

For students who are graduating in December, you are eligible to remain enrolled in the plan until the end of the plan year, which is July 31.  You have the option to withdraw from the plan at the end of the fall insurance term, which is December 31.  In order to opt out of the SMIP, you must notify Duke by completing the Insurance Change Request Form no later than 5pm on December 31.  If you opt out of the SMIP, your student account will be refunded the prorated amount for the spring term insurance premium.  Students who have not submitted this form by the deadline will remain enrolled in the plan until July 31.  December graduates who have dependents enrolled on the insurance plan should be aware that opting out of the plan before the end of the plan year will also terminate the coverage of your enrolled dependents.

For students graduating in September….

Insurance coverage cannot be extended past the end of the insurance plan year for students who have graduated who are not continuing at Duke.  Students who are enrolling in a new degree program at Duke (i.e. an undergraduate student who graduates in May and enrolls in a graduate program to start in August) will be able to enroll in the insurance plan as a continuing student.

For students who are transitioning out of Duke and who need to enroll in an insurance policy to help bridge the gap between the Duke SMIP and enrollment in another insurance plan, we recommend exploring short term insurance.  

In North Carolina, there are multiple companies that provide short term health insurance.  These plans can be used on a month-to-month basis.  Students who enroll in a short term plan must typically stay enrolled in the policy for at least one month, but cannot exceed four months of enrollment. This short term policy cannot be used to waive the SMIP requirement for the Fall and/or Spring Semesters, as it is a short-term policy only.    

To learn more about this option, visit one of the carriers authorized to provide short term health insurance in North Carolina:

• United Healthcare
• Allstate Insurance
• Pivot Health

For students who live outside of North Carolina or are relocating out of North Carolina after graduation and need coverage, please note that short term health insurance is not available in all states.  This website may provide helpful information regarding the availability of short term insurance plans in your state.

Provision of these details and resources does not constitute an endorsement of any specific carrier or plan.

Q: If I am seen at Duke Student Health, will they charge my insurance?

A: There are many services that are provided at Duke Student Health at no additional cost, as they are covered by your Student Health Fee.  Certain services do have an additional cost and will be billed to your health insurance.  This includes lab tests, immunizations and tuberculosis (TB) testing, travel services, x-rays, and EKGs.  Your insurance will also be billed for certain supplies or equipment needed for procedures, such as Intrauterine Devices (IUDs).  Your medical provider can provide more information about services that will have additional cost during your visit.

For students who do not wish to use their insurance for certain services…

Q: How do I get a copy of my insurance card?

A: For students enrolled in the Duke Student Medical Insurance Plan or Dental Insurance Plan, navigate to the Gallagher Student Insurance Portal and select “Get an ID Card” in either the SMIP or Dental section of the webpage.

You can also download the Blue Connect app and access your medical insurance card there.

Physical cards are generally mailed a few weeks after the start of the plan. 

For students who are not on the SMIP, we recommend visiting your health insurance provider’s website.  Instructions should be available on how to access your card.

We strongly recommend students keep a copy of their insurance card on their phone.  There are many options available for this.  Some insurance carriers offer an app where you can keep your card.  Others may allow you to save a copy in the Wallet of your phone.  You can also take photos of your insurance card (or your parent /guardian’s card if you are a dependent on someone else’s plan) and save the photos as a favorite.  Be sure you have a photo of the front and back of your card and be sure you have both your health insurance as well as any pharmacy cards.

Q: What is my Group Number or Member Policy Number?

A: The Duke Group Number is 14162853.  Your Policy Number will be the same as your Duke Unique ID.  Here is a helpful handout that explains all of those numbers on your insurance card and when you may need to use them. 

Q: Is this the same as the health fee?

A: No, the student medical plan is an important part of supporting Duke students’ health and well-being, but it is not the same as the Student Health Fee.  In addition to the medical plan, Duke offers a wide range of health and wellness services, many of which are already covered in your Student Health Fee.  This includes:

• Duke Student Health – our on campus medical clinic
• Counseling & Psychological Services – offering mental health and psychiatric care
• Nutrition Resources and Information, and
• A vast array of wellness promotion, education and programming, non-clinical case management support, and more.

Students who waive out of the student medical insurance plan continue to have access to these other services through their health fee.  

Q: Who is Gallagher and why do I need to submit my information to them?

A: Gallagher Student Health & Special Risk is the university's partner in administering the student insurance plan.  They are a national leader in supporting universities in administering these plans and must meet rigorous state and national regulatory requirements for insurance plan management.  They are held to the same stringent health privacy laws as all other healthcare entities and are a committed partner in providing high quality support and service to our Duke student community.

Q: I need a letter stating I have Duke SMIP coverage. How can I get this?

A: For students enrolled in the SMIP, you can generate this letter within the Gallagher Student Insurance Portal.  To do so, follow these steps:

Students can also contact shs-insurance@duke.edu for support.

Q: Why does Duke require me to have insurance?

A: Here at Duke, we prioritize the health and well-being of our students. Life without health insurance carries serious risk to our students’ health, wellness and personal finances. To ensure access to adequate health insurance coverage, Duke University requires that all students enroll in or waive out of the university’s student medical insurance plan.

If you are in need of assistance with navigating this requirement or assessing options for meeting the requirement, please contact us at shs-insurance@duke.edu.

Q: What happens if I take a leave of absence?

A: Update in progress. Check back soon.

Q:  Am I covered while traveling and/or studying abroad?

A: Yes, your plan covers you wherever you are. This includes out of the Raleigh-Durham area, outside of North Carolina, and internationally.  If you are enrolled in SMIP and paid the premium, you will be covered. 

Your plan also provides you with 24-Hour Worldwide Travel Assistance, which includes services ranging from a lost passport to helping with emergency medical assistance or arranging emergency medical evacuation or repatriation of remains. It’s important to contact Geoblue (855-445-1301) before making arrangements on your own. Otherwise, these services will not be covered. 

Other information about seeking medical care abroad: 

• Always keep your insurance ID card(s) with you. 
• Save a copy of the plan brochure and/or bookmark your student health website. 
• If you get sick while abroad, you will likely need to pay for your care first and then submit bills for reimbursement. Your covered expenses will likely be considered an out-of-network expense. 
• Before you submit claims for reimbursement, have the itemized bill(s) translated into English. Also include a letter informing the claims administrator you already paid for the healthcare service and need to be reimbursed. 
• Write your name, ID number, address and school name on your bill(s). This will help the claims company process your reimbursement request correctly and promptly. 

Q: I am not enrolled in the SMIP and have chosen to maintain my own private health insurance.  I am traveling internationally for a Duke study abroad, field study, or other experience and they require that I have insurance that covers me internationally.  I don’t want to drop my current insurance.  Can I enroll in the SMIP short term to provide coverage while on this trip?

A: Joining the SMIP for short term coverage is not an option to meet this need.  That said, typically you can meet the requirement of having international health insurance coverage by purchasing a short term third party plan.  Companies that offer these types of traveler’s health insurance plans include Allianz or GeoBlue.  There are usually a range of coverage levels available and you are typically able to obtain these plans fairly quickly and the cost is typically quite reasonable. Please directly confirm with the program you are traveling with that one of these plans would meet their requirements.  

Q: I am studying abroad in the fall. Do I need to complete the waiver / enrollment process now or in the spring?

A: Update in progress. Check back soon.

Q: I have a compliment, concern, or complaint.  How can I share this with departmental leadership? 

A:  We welcome your feedback and suggestions on our well-being services, including Student Health, Student Health Insurance, and Counseling & Psychological Services.  Please share your feedback with us via our online form. You may also call us at 919-681-9355 (Student Health) or 919-660-1000 (CAPS).

Q: I am an international student.  Can I opt out of Duke’s student insurance plan?

A: Students on an F1/J1 visa are not able to opt out of the student medical insurance plan and are automatically enrolled in both the medical and dental insurance plans.  Students are able to opt out of the dental insurance plan.  

To opt out of the dental insurance:

• Visit https://www.gallagherstudent.com/duke and follow the log-in instructions
• Once in the portal, you can complete the opt-out process following the prompts on the website in the dental plan section.
• Monitor your Duke email for a follow up email from Gallagher regarding approval of your waiver, confirmation of your enrollment, or requests for any follow-up information.
• Once you receive an approval confirmation email, you are all set!  This action is required only once per academic year.

Q: Why are only F1/J1 students required to participate in the SMIP?  Why isn’t the SMIP mandatory for other international students on non-F1/J1 visas?

A: F-1 and M-1 students have the responsibility to purchase health insurance for themselves and their families while they study in the United States. The Student and Exchange Visitor Program-certified school a student attends may provide health care during studies; however, requirements and fees associated with health coverage differ from school to school. Students should speak with their designated school officials (Duke Visa Services departmental liaison) to consider.

J-1's and their dependents are required by law to have health insurance, which Duke Visa Services has detailed here.

Q: Do I need to provide documentation of this plan to the Duke International Student Center?

A: No, you do not need to provide documentation of your health insurance to the DISC team or to Duke Visa Services.  

We do strongly recommend students keep a copy of their insurance card on their phone.  There are many options available for this.  Some insurance carriers offer an app where you can keep your card.  Others may allow you to save a copy in the Wallet of your phone.  You can also take photos of your insurance card and save the photos as a favorite.  Be sure you have a photo of the front and back of your card and be sure you have both your health insurance as well as any pharmacy cards.

Q: I am only here for a short-term program.  How long will my insurance coverage last?

A: Health insurance for international students who are enrolled in short-term programs at Duke will have health insurance coverage that is based on the program dates.  The cost of the insurance premium for these plans will be prorated for the length of the program.  

Q: Am I required to have health insurance in order to maintain my immigration status? Are my dependents?

A: Students on an F1/J1 visa are not required by the United States government for maintaining a student visa, however enrollment in the Student Medical Insurance plan is mandatory at Duke University.  Dental insurance is strongly recommended, but not required for international students on an F1/J1 visa. 

Insurance is not required for dependents, however it is strongly recommended.

The healthcare system in the United States operates in a manner that is very different from many other countries, particularly those that have national health systems or universal health coverage.  This means that the cost of basic or primary care as well as urgent or emergency care can be much higher than students experience in their home country.  Having health insurance is a critical step to managing the costs of receiving care while in the United States.  For a quick overview of how healthcare works in the United States, we recommend watching this short five minute video.

Q: Can I remove my dependents if they return to my home country in the middle of the semester?

A: Once your dependents are enrolled in the dental plan and the enrollment / waiver period has ended, they will remain in the plan through the end of the plan year.  

Q: Does the SMIP provide any coverage for medical care in my home country when I return home during breaks or between terms?

A:  Yes, your plan covers you wherever you are. If you are enrolled in SMIP and paid the premium, you will be covered. Your plan also provides you with 24-Hour Worldwide Travel Assistance, which includes services ranging from a lost passport to helping with emergency medical assistance or arranging emergency medical evacuation or repatriation of remains. It’s important to contact Geoblue (855-445-1301) before making arrangements on your own. Otherwise, these services will not be covered. 

Other information about seeking medical care abroad: 

• Always keep your insurance ID card(s) with you. 
• Save a copy of the plan brochure and/or bookmark your student health website. 
• If you get sick while abroad, you will likely need to pay for your care first and then submit bills for reimbursement. Your covered expenses will likely be considered an out-of-network expense. 
• Before you submit claims for reimbursement, have the itemized bill(s) translated into English. Also include a letter informing the claims administrator you already paid for the healthcare service and need to be reimbursed. 
• Write your name, ID number, address and school name on your bill(s). This will help the claims company process your reimbursement request correctly and promptly.

Q: Are insurance options available for my family?

A: Yes, Duke offers both medical and dental insurance coverage for dependents of Duke students.  Students who are interested in enrolling their dependents must directly enroll them via the Gallagher portal.  Payment for the insurance premium for dependents is made straight to Gallagher for this coverage.  Please note:  you may only enroll your dependents if you are enrolled in the student plan.  

The plan benefits for dependents are the same as those for enrolled Duke students.  For information on the annual insurance premiums for dependents, please visit…

Q: How do I enroll my dependents?

A: In order to enroll dependents, you must be enrolled in the medical and/or dental insurance plans as well.

During the annual enrollment /waiver period, you can enroll your dependent(s) by following these steps:

1. Go to https://www.gallagherstudent.com/duke. 
2. Follow the login instructions. 
3. Click on the “Enroll” button under “Plan Summary.” 
4. Follow the instructions to complete the form to enter and enroll your “dependent spouse/partner” and/or “dependent children.” 
5. Submit documentation of your relationship.
6. Receive approval from Gallagher within one to three business days as well as a link to pay for coverage.
7. Make the initial payment for dependent coverage directly to Gallagher.
8. Enrollment confirmation will be sent. 

Please be aware that you must purchase dependent insurance for the same coverage period as your own coverage; it can’t be for a longer or shorter period than your own. You must also complete the enrollment for both yourself as well as your dependents during the annual enrollment / waiver period.  If you enroll for annual coverage and do not enroll your dependents at that time, you cannot enroll your dependents unless a qualifying event occurs. 

Note: If enrolling a dependent for the first time, documentation needs to be uploaded at the time of submission. For example, a marriage certificate for a dependent spouse or birth certificate for a dependent child. 

Q: What is the deadline for enrolling my dependents?

A: For students starting at Duke during the fall semester as well as continuing students, dependents must be enrolled during the annual enrollment / waiver period.  This occurs each year between mid-June and September 15.  Dependents who are not enrolled by September 15 will not be eligible to be enrolled in the plan until the next annual enrollment / waiver period unless there is a Qualifying Life Event.

Students who start at Duke during the spring semester or who were not enrolled during the fall and are returning during the spring semester must be enrolled during the spring enrollment / waiver period, which is typically mid-November through January 31.  Dependents who are not enrolled by January 31 will not be eligible to be enrolled in the plan until the next annual enrollment / waiver period unless there is a Qualifying Life Event.

Duke does not offer dependent coverage for students who are on short-term plans, which are typically one to four months for short certificate or credential programs.

Q: Who qualifies to be enrolled as a dependent?

A: Dependents who may be covered by the Duke University student medical or dental insurance plans are:

• Spouses and domestic partners
• Children (biological, adopted, stepchildren, and foster children) under the age of 26

Enrolled students will be required to submit documentation to verify their relationship with their dependents.  Documentation may include a marriage certificate for dependent spouse or a birth certificate for a dependent child.  For students in a domestic partnership, an affidavit must be submitted and is available here.

If you have questions regarding your dependents, whether an individual is eligible to be enrolled as a dependent, or regarding the documentation that may be needed for dependent verification, please connect with Gallagher by using the Contact Us form on the Help Center website or by calling 866-931-5275.

Q: Why do I have to submit documentation to enroll my dependents?  I didn’t have to verify our relationship last year.

A: Submission of documentation to verify your relationship with your dependents is a standard requirement for health insurance coverage. We understand that this adds an additional step in the process, but it is an important step to help us maintain our robust and comprehensive health insurance plan while working to keep it as affordable as possible for our student community.  You will only need to complete this step the first year your dependents are enrolled in the plan.

Q: I am in a domestic partnership.  Can I enroll my partner as a dependent?

A: Yes, you can enroll your partner as a dependent.  In order to do so, you will need to complete this affidavit, which serves as verification of your relationship.  This completed affidavit must be submitted directly to Gallagher for enrolling your partner via their confidential student health insurance portal.  

Q: Both my partner and I are enrolled as Duke students.  Should we both enroll individually with SMIP or should one of us enroll and then add the other as a dependent?

A: If you and your spouse or partner are both enrolled students at Duke, you both need to meet the insurance requirement, but you can do so through either individual enrollment in the SMIP or by having one person enrolled and then adding the other as a dependent.  We recommend you evaluate the options and make the best decision for your family.  However, there are a few things to keep in mind as you make your decision:

• Are you both Ph.D. students who will have your benefits directly covered by your program?
• Will it just be you and your partner or do you also have additional dependents you will be adding?
• Keep in mind how the annual out-of-pocket maximums accrue for individuals vs. student + spouse, student + child(ren),  or student + family.

If you opt to enroll one of you as a dependent of the other, the student who is enrolled as a dependent still needs to provide proof of insurance coverage to the university.  You will need to wait until after August 1 when the plan becomes active to complete this process.  At that point, you will receive an insurance card and will be able to both add your dependent to your plan as well as have proof of insurance for the non-enrolled spouse to upload to the Gallagher portal in order to waive their own individual coverage.

Q: Can my dependents be seen at Duke Student Health or Counseling & Psychological Services since they are enrolled in the Duke SMIP?

A: Duke Student Health and Counseling & Psychological Services provide care to enrolled Duke University students only. Fortunately, Duke University operates a world class health system right here in Durham!  Students are encouraged to seek a Duke community medical provider for their dependents and can locate available medical providers using the Duke provider search website.

For students who are not enrolled in the Duke SMIP but are seeking medical care for their dependents, we recommend starting with your insurance company to identify providers who accept your health plan.  The website for identifying covered providers is typically listed on the back of your health insurance card.  Duke University Health System accepts a wide range of insurance plans, so you may also be able to find a Duke medical provider for your dependents via the provider search website.

Q: Will my dependents automatically stay enrolled from year to year?

A: No, your dependents will not automatically stay enrolled from year to year.  You will need to re-enroll your dependents each year during the annual enrollment / waiver period that takes place from mid-June to September 15.  You will only need to provide documentation the first time you enroll your dependent. 

Q: How do I pay for my dependents’ enrollment?

A: Payments for dependent coverage are made directly to Gallagher via the student insurance portal.  Students are able to pay the full annual premium at one time or break the premium into monthly installments.  

When enrolling dependents in the plan, you will submit their information through the student insurance portal.  The first time you enroll your dependents, you will also need to provide documentation of your relationship.   Gallagher will review the submission.  Once your submission and documentation has been approved, you will receive a link to your email to pay for the premium and activate their coverage.

To enroll in a payment plan, students must pay for the first three months of medical coverage at the time of enrollment.  Students will then receive a payment link 10 days prior to the premium due date each month for the remaining nine monthly payments. The payment link is active for 14 days. Students must ensure they pay these monthly installments on time to avoid any interruption in coverage.  

For questions related to the payment process, please connect with Gallagher by using the Contact Us form on the Help Center website or by calling 866-931-5275.

Q: My dependents had health insurance during the annual enrollment / waiver period, so I didn’t enroll them.  Their situation has changed.  Can I enroll them in the plan now?

A:  You can enroll a dependent in the plan after the end of the enrollment /waiver period in many circumstances. Loss of insurance coverage is categorized as a Qualifying Life Event. Other Qualifying Life Events include: 

• Reaching the age limit of another health insurance plan, which typically means turning 26 and no longer qualifying for coverage under a parent or guardian’s plan. 
• Involuntary loss of coverage from another health insurance plan. 

You may also be able to enroll a dependent in the plan outside of the enrollment period if one of these qualifying events occurs: 

•   You get married 
•   You have a child, adopt a child, or placed a child for foster care 
•   Your dependent enters the country for the first time 
•   Your dependent loses coverage under another insurance plan 

To initiate the process, you must take action within 30 days of the Qualifying Life Event.  To enroll:

1. Go to the Gallagher student insurance portal
2. Follow the login instructions. 
3. Click on “Enroll-Qualifying Life Event.” 
4. Complete the online form and upload the required supporting document, such as the loss of coverage letter from your prior health insurance company showing your name and the last day of coverage. 

Please be aware that you must purchase dependent insurance for the same coverage period as your own coverage; it can’t be for a longer or shorter period than your own. 

Please note: it is important that you read the form carefully as it contains very specific information on the Qualifying Life Event process and you will need to complete the steps exactly as outlined in order to be enrolled in the plan outside of the annual waiver / enrollment period. 

Q: I enrolled my dependents on the plan during the annual enrollment / waiver period.  Can I cancel their plan at any time?

A: Once your dependents are enrolled in the SMIP and the enrollment / waiver period has ended, they will remain in the plan through the end of the plan year.  You will not have the option to waive out until the next annual enrollment / waiver period.  

The only exception to this is for dependents who enter the armed services.  If this is your circumstance, please connect with Gallagher by using the Contact Us form on the Help Center website or by calling 866-931-5275.

Q: One of my enrolled dependents was 25 years old and is now turning 26.  What will happen when they turn 26?

A: Once your dependent turns 26, they will no longer be eligible to be enrolled in the Duke SMIP as a dependent.  You will receive notification from the SMIP insurance carrier regarding this plan termination. Because this is a Qualifying Life Event, your dependent will be able to enroll in another insurance plan immediately upon loss of coverage.  You must take action within 30 days.  

We recommend visiting the health insurance marketplace or exchange for the state where your dependent is residing.  These exchanges allow you to review plans available for purchase in your area and complete the enrollment process online.  If you have questions specific to your situation, please contact our Student Health Insurance Support Team at shs-insurance@duke.edu.

Q: Using my insurance is new for me and I find the process and all the terms very confusing.  Can you help me better understand how to use my plan?

A: We understand that health insurance can be very confusing, especially if this is the first time you are on your own plan.  There are a number of short videos that may be helpful in understanding the basics of health insurance, including key terminology, how to use your plan, and understanding the difference between healthcare in the United States and other countries.  These videos are all available here.

We have a full team available to help provide support and guidance, as well.  For the most expedited support related to your situation, please contact the following:

• For assistance with the Gallagher student insurance portal, benefits questions, or claims assistance – connect by using the Contact Us form on the Help Center website or by calling 866-931-5275
• For all other inquiries, connect with the Student Health Insurance Support Team at shs-insurance@duke.edu or call us at 919-684-1000.

Q: The Duke Student Medical Insurance plan is a PPO.  What does this mean?

A: The Duke SMIP is a Preferred Provider Organization (PPO) Plan.  This means that you have a wider range of medical providers you can choose to see for your care.  There are preferred providers and these are identified as “in-network.”  There is more coverage of your healthcare expenses with these providers than “out-of-network” providers.  Here is a helpful website and very short video that may help better explain PPOs.

With the Duke plan, you will have coverage throughout the United States with a robust network of providers in Durham and beyond.

Q: I received a bill and/or Explanation of Benefits. What do I do?

A: First, it’s important to know that an Explanation of Benefits (EOB) is not a bill.  This helps you understand what is being charged for the healthcare services you received and what portion of that cost your health insurance plan will cover.  You can review a helpful overview of EOBs here.

When reviewing your EOB, it is important to ensure that your health insurance plan was utilized for the visit.  Sometimes, especially in cases of emergency care, your medical provider may not have had information or up to date information on your health insurance.  If you do not see that your insurance plan was utilized, contact your healthcare provider’s billing department to be sure they have up to date information.  

For insurance benefits questions or claims assistance – you can connect with Gallagher by using the Contact Us form on the Help Center website or by calling 866-931-5275.  You can also connect with the Student Health Insurance Support Team at shs-insurance@duke.edu or call us at 919-684-1000. 

When you do receive your bill, look for the Patient Balance–this is the portion of the costs you are responsible for.  If you have concerns related to these costs, you can often work with your healthcare provider to set up payment plans to make these costs more manageable or spread payments out across a number of installments.

Q: Where will bills for services rendered be sent?

A: Bills for services rendered will be sent to the mailing address on file with your healthcare provider.  Students may move a few times while at Duke University, so please be sure that you keep your healthcare provider updated if you move.

Explanations of benefits (EOBs) will typically be sent to the mailing address that is on file for the insurance plan subscriber.  If you are a student under the age of 26 and still on a parent or guardian’s plan, this will mean that EOBs will be sent to your parent/guardian, as it is their address that is going to be on file with your insurance company.  

Q: How do I update my address to ensure I receive notices from my insurance company? 

A: Duke University will automatically provide the address you have on file to Gallagher and our student medical and dental insurance plan carriers.  In order to update your address, you must update your mailing address in Duke Hub https://dukehub.duke.edu/.  

If you do not update your address in Duke Hub, the system will continue to automatically send your old address to Gallagher and overwrite any changes you may have made with just Gallagher / Blue Cross Blue Shield.

Step-by-step instructions for updating your address in DukeHub are available here.

Q: Who will be able to see information about how I have used my insurance plan?

A:   If you are enrolled in the Duke Student Medical or Dental Insurance plans, only you as the student will be able to see this information, unless you have provided your parent, guardians, or others with login information for your health insurance carrier’s website / portal or your healthcare provider’s online patient portal.  

If you are a dependent on your parent or guardian’s plan or on your spouse’s plan, they will be able to see information on how your plan has been used and services received unless you have directly connected with your insurance provider on options related to keeping your care confidential from the policyholder.

Q: I am a dependent on my parent or guardian’s insurance.  Is it possible to prevent my insurance company from sending Explanations of Benefits (EOBs) to my parent or guardian?

A: There are options for you to work with your insurance company directly related to privacy and confidentiality of your care and EOBs that result from that care.  Recommendations for working with your insurance company around where information is sent include: 

1. Call your insurance company directly using the information on the back of your health insurance card.  
2. Request confidential communication and specify that you want EOBs and other healthcare communications to be sent directly to you instead of to the policyholder and provide your mailing address.
3. Clarify the process for requesting this.  It may involve completing a specific form or you may be able to verbally make this request.
4. Be ready to provide necessary information, including your name, member and policy ID number, and the address where you would want information.

Please keep in mind that insurance companies are large entities and that implementation of these protocols can sometimes take some time.  So if you have recently received care and are requesting this type of change, there may be delays from the timing of your request and when it is implemented.  Your insurance company may also have policies on these types of requests, so working directly with them will be important for understanding your options.

Q: How do I locate an in-network provider?

A: If you are enrolled in the Duke Student Medical or Dental Insurance Plan, you can locate an in-network provider by visiting the Gallagher Student Health Insurance Portal and clicking “Find a Doctor” in the medical or dental section of the page.

If you are enrolled in other private health insurance, visit your health insurance carrier’s website.  You may also find information on locating a provider on the back of your health insurance card.

Q: Do I need a referral from Duke Student Health to access services in the community?

A: No, you do not need a referral from Duke Student Health to access services in the community.  If you are in need of specialty care, you may need a referral from a primary care provider.  If you need support connecting to care in the community or if you have questions regarding specialty referrals, you can connect with our team at shs-insurance@duke.edu.  

Q: Will I have an assigned primary care provider (PCP)?

A: The Duke University SMIP does not require that you designate a primary care provider and will not automatically designate one for you, either.  Primary care providers are very important for your health and well-being and are typically medical providers who specialize in family medicine, internal medicine, or pediatrics.  

Q: Where can I fill my prescriptions?

A: If you are enrolled in the Duke Student Medical Insurance Plan, you can locate an in-network pharmacy by visiting the Gallagher Student Health Insurance Portal and clicking “Pharmacy Program” in the medical section of the page.  The SMIP is accepted at a wide range of pharmacies, including the Duke Student Wellness Center Pharmacy, Duke University Health System Pharmacies, Walgreens, CVS, and other major retailers. Mail order pharmacy services are available as well.  

Q: Do I have to use the pharmacy in the Wellness Center?

A: No, you may use the pharmacy of your choice.  The Wellness Center Pharmacy is conveniently located for students and accepts prescriptions from medical providers at Duke as well as external and community healthcare providers.  The pharmacy accepts a wide range of insurance plans.  

If you prefer to use a pharmacy in the community, simply let your medical provider know your pharmacy preference and be sure they accept your health insurance plan.

Q: How can I check the status of a pending claim?

A: If you are enrolled in the Duke SMIP, you may check the status of a claim at blueconnectnc.com.  For assistance with benefits questions or claims assistance, you can also connect with Gallagher for support by using the Contact Us form on the Help Center website or by calling 866-931-5275

If you are not enrolled in Duke SMIP, you may contact your insurance carriers customer service department for assistance.  Typically, information for contacting them is available on the back of your medical insurance card or is outlined on your insurance carrier’s website.

Q: I don’t think the payment the insurance company made on my claim was correct. How can I appeal?

A: To appeal claims you must contact your insurance carrier. If you are enrolled in Duke SMIP you may contact Blue Cross Blue Shield at 888-234-2417.  For claims related to the Duke dental insurance plan, please contact Aetna Dental PPO at 877-238-6200.

Q: I enrolled in the medical plan. How long do I have to wait until I can see a medical provider?

A: There is no waiting period to see a medical provider with the Duke SMIP.  Once the plan becomes active on August 1 (or January 1 if you are starting at Duke in the spring term), you are able to begin using your insurance coverage right away.

Q: I submitted my insurance information.  Will Student Health and the Wellness Center Pharmacy automatically have my information?

A: No, these teams will not automatically have your information.  During your first visit to Student Health or a Duke Health provider, you will need to supply your insurance information during the check-in process. Once entered, the insurance information will be available throughout Duke Health, including Duke pharmacies.

It is important you keep your information up to date, so if your information changes, be sure to let these teams know during your next visit.

Q: My insurance has changed and I need to update the information on file.  What do I do?

A: Please notify your healthcare provider if your insurance information has changed.  With some healthcare providers, you may be able to provide this updated information via a patient portal.  In other circumstances, you may just need to provide the updated information during your next visit.  Be sure you keep updated copies of your information on your phone or close by so you have them if you need them.

A: Please notify your healthcare provider if your insurance information has changed.  With some healthcare providers, you may be able to provide this updated information via a patient portal.  In other circumstances, you may just need to provide the updated information during your next visit.  Be sure you keep updated copies of your information on your phone or close by so you have them if you need them.

Q: Are dental insurance options available?

A: Yes. Duke Student Insurance is partnered with Aetna Dental to provide dental coverage for students and their dependents. You may find more information on the university’s dental insurance plan or enroll by visiting the  Gallagher student insurance portal.  Enrollment in the university's dental plan occurs during the same annual enrollment / waiver period as the medical plan, so students interested in enrolling in the plan must ensure they complete this voluntary enrollment before the deadline.

Q: What are the dental insurance plan benefits?

A: Duke has partnered with Aetna Student Health to provide an enhanced dental plan for students. The Aetna dental plan provides 100% coverage (up to the policy limits) at all In-network providers.  This includes Campus Smiles, the dental clinic conveniently located in the Duke University Wellness Center.  This plan can be used nationwide. Full details on the dental plan benefits by visiting the Gallagher student insurance portal and clicking on Plan Materials in the Dental section of the webpage.

Q: What is the cost of the dental insurance?

A: The annual premium costs for the medical insurance plan are updated each year in mid to late May and published on our website.

Q: Can I sign up for the dental insurance at any time?

A: Enrollment in the university's dental plan occurs during the same annual enrollment / waiver period as the medical plan, so students interested in enrolling in the Duke University dental plan must ensure they complete this voluntary enrollment before the deadline.

If you have missed the deadline for enrollment in this voluntary plan, there may be options available for you to enroll through dental insurance marketplaces in North Carolina, but it will not be the university’s dental plan.  

Q: How do I enroll?

A: Ph.D. and F1/J1 students are automatically enrolled in the dental insurance plan, so no action is needed.   To view your coverage details: 

1. Go to https://www.gallagherstudent.com/duke . 
2. Follow the login instructions. 
3. View “Account Details,” found on the lower left side of landing page. 

For non-Ph.D. and non-F1/J1 students, you can voluntarily enroll in dental coverage by following these steps:

1. Go to https://www.gallagherstudent.com/duke . 
2. Follow the login instructions. 
3. View “Account Details,” found on the lower left side of landing page
4. Click on “Enroll”

Q: I am a Ph.D. or F1/J1 student and was automatically enrolled in dental insurance, but I would like to opt out.  How can I do that?

A: To opt out of the dental plan, you must take action before the end of the waiver / enrollment period.  To opt out: 

1. Go to https://www.gallagherstudent.com/duke . 
2. Follow the login Instructions. 
3. Scroll down to the “dental plan summary” section 
4. Select the email address (Quincy.BSD.enrollmentteam@AJG.com) to opt out. This link will generate a pre-filled in email confirming that you are opting out of dental coverage. 
5. Please send the email to the pre-populated email address. 

You will see a credit on your student account for the cost of the dental insurance premium in 7 to 10 business days.

Students who have not opted out by the end of the enrollment / waiver period will remain enrolled in the dental plan until the next annual enrollment / waiver period and will be responsible for the cost of the dental plan premium.  

Q: Can I enroll my dependents in dental insurance?

A: Yes, the Duke University dental plan is available for dependents.  In order to enroll dependents, you must be enrolled in the dental insurance plan as well.

During the annual enrollment /waiver period, you can enroll your dependent(s) by following these steps:

1. Go to https://www.gallagherstudent.com/duke. 
2. Follow the login instructions. 
3. Click on the “Enroll” button under “Plan Summary.” 
4. Follow the instructions to complete the form to enter and enroll your “dependent spouse/partner” and/or “dependent children.” 
5. Submit documentation of your relationship.
6. Receive approval from Gallagher within one to three business days as well as a link to pay for coverage.
7. Make the initial payment for dependent coverage directly to Gallagher. You will be required to pay the full dental premium for each dependent at the time of enrollment.
8. Enrollment confirmation will be sent. 

Please be aware that you must purchase dependent insurance for the same coverage period as your own coverage; it can’t be for a longer or shorter period than your own. You must also complete the enrollment for both yourself as well as your dependents during the annual enrollment / waiver period.  If you enroll for fall coverage and do not enroll your dependents at that time, you cannot enroll your dependents unless a qualifying event occurs. 

Note: If enrolling a dependent for the first time, documentation needs to be uploaded at the time of submission. For example, a marriage certificate for a dependent spouse or birth certificate for a dependent child. 

Q: Where can I use the dental insurance?

A: The Aetna dental plan provides 100% coverage (up to the policy limits) at all in-network providers and features a robust, nationwide network of dental providers.  To find a provider, visit the Gallagher student insurance portal and select “Find a Doctor” in the Dental section of the website.

Q: I enrolled in dental coverage. How long do I have to wait until I can see a dental provider?

A: There is no waiting period to see a provider with the Duke dental insurance plan.  Once the plan becomes active on August 1 (or January 1 if you are starting at Duke in the spring term), you are able to begin using your insurance coverage right away.

Q: Once I enroll, can I cancel the dental insurance?

A: Once you are enrolled in the dental plan and the enrollment / waiver period has ended, you will remain in the plan through the end of the plan year.  You will not have the option to waive out until the next annual enrollment / waiver period.  The only exception to this is for students who enter the armed services who should reach out to our team at shs-insurance@duke.edu for support.

Q: How do I access my dental insurance card?

A: For students enrolled in the Dental Insurance Plan, navigate to the Gallagher Student Insurance Portal and select “Get an ID Card” in either the SMIP or Dental section of the webpage.

You can also register on the Aetna member website, download the Aetna Health app from App Store or Google Play, or text “STUDENT” to 90156 for a link to download the app and register.  When accessing the website/app, you will be able to access the provider directory, look at claim payment details, and retrieve an image of your ID card.

We strongly recommend students keep a copy of their insurance card on their phone.  There are many options available for this.  Some insurance carriers offer an app where you can keep your card.  Others may allow you to save a copy in the Wallet of your phone.  You can also take photos of your insurance card (or your parent /guardian’s card if you are a dependent on someone else’s plan) and save the photos as a favorite.  Be sure you have a photo of the front and back of your card and be sure you have both your health insurance as well as any pharmacy cards.

We understand that understanding insurance and the healthcare system can be challenging.  Please review the information below from our partners at Blue Cross Blue Shield of North Carolina and Duke Health.  These commonly used terms will help you better understand your plan as well as when and where to seek care while at Duke.  

Benefit Period 

The period of time, usually 12 months as stated in the group contract, during which charges for covered services provided to a member must be incurred in order to be eligible for payment by Blue Cross NC. A charge shall be considered incurred on the date the service or supply was provided to a member.

Coinsurance

The sharing of charges by Blue Cross NC and you for covered services, after you have met your benefit period deductible. This is stated as a percentage. The coinsurance listed is your share of the cost of a covered service.

Copayment

The fixed dollar amount you must pay for some covered services at the time you receive them, if this health benefit plan includes copayments. Copayments are not credited to the deductible; however, they are credited to the total out-of-pocket limit.

Coverage

The medical services and treatments that the insurance plan will pay for, either fully or partially. 

Covered service(s)

A service, drug, supply, or equipment specified in the Benefit Booklet for which members are entitled to benefits in accordance with the terms and conditions of this health benefit plan. Any services in excess of a benefit period maximum or lifetime maximum are not covered services.

Deductible

The amount of money you must pay for covered services in a benefit period before Blue Cross NC begins to pay for covered services. The deductible does not include coinsurance, charges in excess of the allowed amount, amounts exceeding any maximum, or charges for non-covered services.

Emergency care

Health care items and services furnished or required to screen for or treat an emergency medical condition, including but not limited to, pre-hospital care, and ancillary services routinely available in the emergency department.

Excluded services

Treatments or procedures that are not covered (excluded) by the insurance plan. 

Explanation of Benefits (EOB)

An EOB is a document that explains the costs for provided health care services and how the insurance plan covered those costs. In an EOB, you will find details about the dates of services, billed amounts, what your insurance plan covered, and any unpaid costs you may owe, including copayments or deductibles.

Formulary

The list of outpatient prescription drugs, insulin, and certain over-the-counter drugs that may be available to members. 

In-network provider

A hospital, doctor, other medical practitioner, or provider of medical services and supplies that has been designated as an in-network provider by Blue Cross NC or a provider participating in the BlueCard® Program.

Ancillary providers outside North Carolina are considered in-network only if they contract directly with the Blue Cross or Blue Shield plan in the state where services are received, even if they participate in the BlueCard program. 

Member

A subscriber or dependent, who is currently enrolled in this health benefit plan and for whom premium is paid.

Out-of-network

Not designated as participating in the plan’s network of covered providers and not certified in advance by Blue Cross NC to be considered as in-network. Our payment for out-of-network covered services is described in the Benefit Booklet as out-of-network benefits or out-of-network benefit levels.

Out-of-network provider

A provider that has not been designated as an in-network provider by Blue Cross NC.

Out-of-pocket limit (or out-of-pocket maximum)

The maximum amount of coinsurance that is payable by the member in a benefit period before Blue Cross NC pays 100% of covered services. It does not include deductible, or any applicable copayments.

Premium

The amount of money that you pay to the insurance company to maintain health insurance coverage. 

Preventive care

Medical services provided by or upon the direction of a doctor or other provider that detect disease early in patients who do not show any signs or symptoms of a disease.

Preventive care services include immunizations, medications that delay or prevent a disease, and screening and counseling services. Screening services are specific procedures and tests that identify disease and/or risk factors before the beginning of any signs and symptoms. 

Qualifying life events

A QLE is a life event that may cause special enrollment. During an QLE, you can enroll in SMIP coverage outside of the annual open enrollment period.

Qualifying life events may include marriage, divorce, birth or adoption of a child, loss of other health coverage, or a change in residence. 

Referral

A recommendation from a primary care provider (PCP) to see a specialist or receive certain medical services. 

Specialist

A doctor who is recognized by Blue Cross NC as specializing in an area of medical practice.

Subscriber

The person who is eligible for coverage under this health benefit plan due to employment and who is enrolled for coverage.

Telehealth

The use of video appointments or phone calls to provide virtual health care services to patients outside of a doctor's office or care facility. 

Total out-of-pocket limit

The maximum amount listed in “Summary of Benefits” that is payable by the member in a benefit period before Blue Cross NC pays 100% of covered services.  It consists of the out-of-pocket expense (which is the annual maximum amount of coinsurance and any copayments) plus the deductible.

Urgent care

Services provided for a condition that occurs suddenly and unexpectedly, requiring prompt diagnosis or treatment, such that in the absence of immediate care the individual could reasonably be expected to suffer chronic illness, prolonged impairment, or require a more hazardous treatment. Fever over 101 degrees Fahrenheit, ear infection, sprains, some lacerations, and dizziness are examples of conditions that would be considered urgent.