DSGHP Coverage Overview

Medical services at Dartmouth College Health Service: $0

• Services will be charged to your student account, then reimbursed once processed by insurance. You do not need to do anything, this happens automatically.

Other providers/facilities (In-Network)

• Deductible: $100 in-network
• Co-insurance: 10% in-network
• Maximum Out-of-Pocket (combination of medical & prescription): $2500 in-network
• Preventive care: $0 in-network
• Emergency Room: $100 co-pay (waived if admitted)
• Ambulance: $100 co-pay
• Outpatient Mental Health:
  • No deductible
  • Co-insurance: 10% in-network

For Out-of-Network out-of-pocket costs, please see DSGHP Plan Document.

Preferred pharmacies (Dick Hall's House Pharmacy, Dartmouth-Hitchcock Pharmacy, Dartmouth-Hitchcock Pharmacy at Centerra & Cheshire Medical Center Pharmacy) per 30-day prescription (no deductible):

• Generic drug copay: $10
• Preferred brand name drug copay: $20
• Non-preferred brand name/specialty drug copay: $50

​​​​​​All other pharmacies:

• Deductible: $100
• Coinsurance: 20%

Covered Perscription Drugs:

• Wellfleet Formulary

When seeking medial or mental health care in the United States, you will pay less out-of-pocket by seeing a Cigna OAP provider / facility.

• Go to www.cigna.com to access Cigna's Provider Network. Do not log in, as we are not a Cigna plan we only use the network of providers.
  • At the top, click on "Find a Doctor"
  • Click on "Employer or School" under "How are you Covered?"
  • Enter required information and choose your search type
  • On the pop-up screen, choose "Continue as guest"
  • Click continue, then choose "Open Access Plus, OA plus, Choice Fund OA Plus"