DSGHP Information

• In-network co-insurance decreased to 10%.
  • DSGHP pays 90% of eligible expenses, after deductible (when deductible is applicable).
• In-network deductible decreased to $100/individual and $200/family.
• In-network out-of-pocket maximum decreased to $2500 for an individual plan.
• Referrals from Dartmouth College Health Service are only required for Preventative Care Services (listed under the Affordable Care Act) while in the Hanover, NH area.

Fees

• Student only: $4,163.00
• Student and one dependent: $10,740.00
  • Student: $4,163.00
  • One Dependent: $6,577.00
• Student and Two or more dependents: $13,958.00
  • Student: $4,163.00
  • Two or more dependents: $9,795.00

Spouses enrolled into the plan, are subject to an annual spouse health access fee.  A new Dependent Application must be submitted to the DSGHP Office by the start of each plan year, as dependent enrollment is not automatic.

For "per term" enrollment fees (incoming exchange students or Dartmouth sponsored study abroad enrollments only), please contact the DSGHP office.

Coverage Dates

• New Students: August 1, 2022 – August 31, 2023
• Returning Students: September 1, 2022 – August 31, 2023

Coverage for current plan year terminates on August 31st, unless a student submits a Waiver or Midyear Cancellation Form to cancel on December 31st or March 31st.

For "per term" enrollment dates and waiver information (incoming exchange students or Dartmouth sponsored study abroad enrollments only), please contact the DSGHP office.

REFERRALS FROM DARTMOUTH COLLEGE HEALTH SERVICE ARE NEEDED FOR PREVENTATIVE SERVICES IN THE HANOVER NH AREA.

• Without a referral, preventative services will fall to the out-of-network level, resulting in no coverage. Please see lists of preventative care services that require this referral:
  • For adults: https://www.healthcare.gov/preventive-care-adults/
  • For women: https://www.healthcare.gov/preventive-care-women/

Preferred Pharmacy Information

• ​Preferred Pharmacy Information

Claims Administrator

Claims for services at an out-of-network provider are to be submitted to the Plan for payment within ninety (90) days after services are received and payment is requested.  In-network providers must submit a claim for payment within twelve (12) months of the date of service. 

Wellfleet (Claims Administrator) Log into your Wellfleet account or call customer service toll free at 1-833-443-5338 for the following:

• View or print ID cards and claims
• View coverage information
• Network information
• Claim forms (Medical & Prescription)
• Pharmacy Formulary
• Tax Forms (1095-B & 1099HC)
• Verification of Coverage Letter/HIPAA Letter

How to find an OAP Network Provider

To find an in-network provider and/or facility that is in the Cigna OAP network, you can do one of the following things:  

1. Link to in-network providers in the Cigna's OAP directory:

•  Cigna OAP

2. Call Customer Service to request a list of providers and/or facilities that participate in the Cigna OAP network, based on specialty and geographic area.  The toll-free Customer Service telephone number at Wellfleet for Cigna OAP is 1-833-443-5338. After following the prompts provided, you will need to give the Customer Service Representative your Policy & Group numbers.  Note: If you or your provider call the main number to Cigna, they will not be able to assist in locating a provider in-network.

We strongly encourage that once you have found a provider, you check with them to confirm that they are in the Cigna OAP network as network status can frequently change.

Basix Dental Savings Program

• Members of the DSGHP have access to the Basix Dental Savings Program, which is a network of dentists who have agreed reduce charges for dental services. Visit the Basix website to find a dentist and see the discounts they offer, all over the US.

DSGHP Office (This office is remote)

• Enrollment, waiver, and general claims/coverage assistance
  • Phone: 603-646-9438 or 603-646-9449
  • Email: Dartmouth.Student.Health.Plan@Dartmouth.edu

Dartmouth College Health Service

• Medical Services call: Primary care and Women's Health (603) 646-9401
  • For referrals for preventative care outside of the Health Service, in the Hanover, NH area, you may need to schedule and appointment.
• Mental Health Services call: Counseling Department (603) 646-9442

Resource Documents

These documents are available to help you compare health plans and make a coverage decision that's right for you.

2022-2023 Information:

• 22 - 23 DSGHP Brochure
• 22 - 23 DSGHP Plan Document
  • This is a draft version and is subject to change.
• 22 - 23 DSGHP Summary of Benefits and Coverage (SBC)
  • This is a draft version and is subject to change.

Other DSGHP information:

• Health Coverage Glossary
• Non-Discrimination Notice​
• Important Creditable Coverage Notice About Your Prescription Drug Coverage and Medicare