Benefits

Outside of the Annual Open Enrollment Period, you can enroll in the West Chester Area School District’s Benefit Program, change your enrollment, or cancel coverage only if you experience a Qualifying Life Event (QLE).

What is a QLE?

A change in your situation - such as getting married, having a baby, or losing health coverage - that can make you eligible for a Special Enrollment Period, allowing you to enroll in health insurance outside the District’s annual Open Enrollment Period. Below are examples of QLEs.

• Birth/Adoption/Gaining a Dependent through a Qualified Medical Support Court Order (QMSCO)
• Marriage
• Divorce or Legal Separation
• Death of the Policyholder
• Involuntary Loss of Employer Sponsored Coverage or Medicaid Coverage
• Exhaustion of COBRA
   

What do I do if I have a QLE?

Employees must notify Human Resources within 30 days of the QLE and provide proof of the QLE to Human Resources.

When will the change become effective?

The effective date of the change will reflect the date of the Qualifying Event. For example, if you have a baby born on August 1st and you notify Human Resources of the change on August 15th, the benefit effective date of the change will be August 1st. Please be prepared to provide documentation of the Qualifying Event to Human Resources.

Helping you make the most of your healthcare benefits. 

Gallagher is ready to help you get the most from your benefit programs by providing an advocate at no cost to assist you with:

• Explanation of benefits. Is it unclear to you what the insurance covered on a particular claim and what is your responsibility?
• Prescription/pharmacy problems. Is the pharmacy telling you that your medication is not covered or charging you full price? Do you need help getting an authorization on a medication?
• Benefits questions. Are you unsure if the insurance will pay for a certain procedure?
• Claim issues. Did you receive a bill from a doctor but don’t know why?
• Difficult situations. Are you having difficulty getting a referral? Has the insurance carrier denied a procedure and you want to appeal their decision?

You have a dedicated Advocate ready to handle any situation in a discreet and confidential manner.

The services provided by an Advocate does not ensure or guarantee benefits. Applicable plan documents containing information regarding all terms, conditions and exclusions of coverages shall govern Consulting and insurance brokerage services to be provided by Gallagher Benefit Services, Inc. and/or its affiliate Gallagher Benefit Services(Canada) Group Inc. Gallagher Benefit Services, Inc. is a licensed insurance agency that does business in California as “Gallagher Benefit Services of California Insurance Services” and in Massachusetts as “Gallagher Benefit Insurance Services.” Neither Arthur J. Gallagher & Co., norits affiliates provide accounting, legal or tax advice. 

• Gallagher PHI Release for Advocate Services Form

The PHI Release form will need to be fully completed, signed dated by your dependent, authorizing yourself to receive information on his/her behalf.

Please use the following instructions in order to complete the HIPAA form.

• Employer Name – Write the name of the employer providing the insurance here.
  • West Chester Area School District.
• Carrier Name – Write the name of the insurance company related to this request here.
  • Independence Blue Cross, CVS/Caremark,  Delta Dental or Trustmark Vision.
• Employee Name - Write the name of the person who works for the employer here.
• Employee ID - Write the employee’s Insurance ID number here.
  • This is the number on the applicable insurance card.
• Patient Name – Write the name of the patient related to this request for assistance here.
• Address -  Write the Patient’s home address here.
• Birth Date - Write the Patient’s date of birth here.
• Phone Number -  Write the Patient’s phone number here.

Authorization Section:

• First Blank Space after the word “authorize” – In this space please write “Gallagher Benefit Services”.
• Parenthesis after the word “release” – Circle letter “b” which authorizes Gallagher Benefit Services to share your PHI related to your healthcare and claims processing with the person you designate.
• (Name/Office and Address)– In this space write the name and address of the person you are allowing the Benefit Advocacy Center to share your PHI with.

Section Letters A – D:

• Circle letter “B” which authorizes the individual you designated to inquire with the Benefit Advocacy Center on your behalf regarding insurance claims and pre-authorization purposes.
• Patient (or legal representative) box - Write your signature and the date in this box.  If the Patient is your dependent child over the age of 18 please have them write their signature and date in this box.
• Relationship to Patient - Write “Self” or other identifier and the date in this box.

Do not hesitate to contact the Benefit Advocacy Center if you have any questions about completing the HIPAA form.
Don’t forget to sign and date the form before sending!