Health Services Forms
Required Immunization Form
To comply with New York State regulations, all students are required to fill out the College’s immunization form (and exemption to immunization, if necessary). Students who are fully remote and will not be coming to campus for any reason do not have to submit their immunization records. Completed forms may be emailed to firstname.lastname@example.org.
Vaccinations will be required for all students attending the College of Mount Saint Vincent, with exemptions for medical reasons and sincerely held religious beliefs.
Request for Immunization Exemptions – Medical or Religious
Students who would like to apply for a medical or religious exemption should complete the immunization exemption form and submit with accompanying documentation. Review of exemption requests will take approximately ten business days so please submit your request with adequate time for review. Questions regarding this process should be directed to email@example.com.
Students who are enrolled in clinical or student teaching programs may be required to show proof of COVID-19 vaccination as required by their off-site location. Off-site clinical or teaching placements may not allow for medical or religious exemptions at their facilities, and in such case they do not, the College cannot ensure that a placement that does not require a COVID-19 vaccine will be available. Students with questions about off-site clinical or teaching placements should direct them to their academic department.
Measles, Mumps, and Rubella (MMR)
New York State Public Health Law requires that full and part-time students must submit proof of immunity to Measles, Mumps, and Rubella (MMR).
Meningococcal Meningitis Vaccine
New York State Public Health Law requires all college and university students to either receive the vaccination against Meningococcal meningitis, or acknowledge that they have been made aware of the risks and have chosen not to be vaccinated. All residents are required to receive the vaccination; they may not sign the waiver.
Is there a vaccine to prevent meningococcal meningitis?
There are vaccines available which may help to prevent the five serogroups of Meningitis.
Menactra or Menveo (meningococcal conjugate vaccines) is the preferred vaccine for people ages 2-55. It helps to protect against Serogroups A, C, Y, W-135.
Bexsero or Trumenba help to protect against Serogroup B. According to the CDC, all adolescents and young adults (16 through 23 years of age) may also be vaccinated with a Serogroup B meningococcal vaccine, preferably at 16 through 18 years of age. CDC recommends that certain adolescents and young adults should be vaccinated with a Serogroup B meningococcal vaccine. They include those at increased risk because of a Serogroup B meningococcal disease outbreak and people with certain medical conditions.
All College students, especially first-year students living in a residence hall are recommended to be vaccinated with Menactra or Menveo vaccine. If they received this vaccine before their 16th birthday, they should get a booster dose before going to college. You must document that you received the Meningitis Vaccine(s) to live in our residence halls.
What is meningococcal disease?
Meningococcal disease is a severe bacterial infection of the bloodstream or meninges (a thin lining covering the brain and spinal cord). It is caused by Neisseria meningitidis also known as meningococcus.
How is the meningococcus germ spread?
The meningococcus germ is spread by direct close contact with respiratory or throat secretions or the saliva of an infected person. Up to one in ten people carry this germ in their nose or throat without any sign of illness but others may develop serious symptoms.
Who gets meningococcal disease?
Anyone can get meningococcal disease, but it is more common in infants and children, followed by a second peak in adolescence. Infants less than one year and adolescents ages 16 through 23 years have higher rates of contracting the disease than other age groups but cases occur in all age groups including the elderly. For some adolescents, such as first year college students living in residence halls there is an increased risk of meningococcal disease.
What are the symptoms?
Symptoms may include high fever, headache, stiff neck, vomiting, weakness, altered mental status (confusion), skin rash and feeling very ill. The symptoms may appear two to ten days after exposure but usually within five days. Among people who develop meningococcal disease, 10 to 15 percent die, in spite of treatment with antibiotics. Of those who live, permanent brain damage, hearing loss, kidney damage, loss of arms or legs, or chronic nervous system problems may occur in about 10 to 20 out of every 100 survivors.
How do I get more information about meningococcal disease and vaccination?
Contact your family health care provider. Additional information is also available on the website of the Centers for Disease Control and Prevention (CDC).
Because of health conditions or other factors, some people should not get certain vaccines or should wait before getting them. Review this with your health care provider.
All full-time undergraduate and graduate students are required to provide proof of health insurance. The College of Mount of Saint Vincent is pleased to offer our students the opportunity to enroll in an affordable, comprehensive health insurance plan for the 2021-2022 policy year. This Plan features:
- Fully compliant with the ACA
- An unlimited policy year maximum
- Annual deductibles: $100 In-Network and $350 Out-of-Network
- Coverage at 90% In-Network and 70% Out-of-Network
- In-Network physician’s office visits covered at 100% after a $25 copay
- Preventive care services with no deductibles, copays or coinsurance (In-Network Only)
- Students will be able to locate providers whether at home, school, or throughout the country through the UnitedHealthcare Choice Plus Network.
- Retail or mail order prescription drug coverage
- Worldwide Travel Assistance including Medical Evacuation, Repatriation, and Political and Natural Disaster coverage
- Wellness discounts including Vision and Dental
- Voluntary Dental available for all students
For a complete description of the benefits available, limitations and exclusions, and FAQs please visit www.gallagherstudent.com/mountsaintvincent.
All Undergraduate students taking 12 or more credits and Graduate students taking 6 or more credits are automatically enrolled in and billed for the Student Health Insurance Plan. If you are insured by a plan that provides comparable coverage, you can request to waive enrollment. Your current plan must provide coverage in the Bronx, NY area. Please see the below instructions to waive coverage for 2021-2022.
International StudentsYou cannot waive coverage unless you are currently enrolled in a fully Affordable Care Act compliant insurance plan through a U.S.-based insurance company and claims administrator.
To enroll in or waive the Student Health Insurance Plan for the 2021-2022 policy year:
- Log on to: www.gallagherstudent.com/mountsaintvincent.
- Click on ‘Student Waive/Enroll’
- Create a user account or Log in (if a returning user).
- Select the ‘I want to Waive/Enroll’ button. If waiving the insurance, you’ll need information found on your current health insurance ID card. Upon completing your online form you will be asked to review the information provided and click ‘submit’ to complete the process. Immediately upon submitting your Online Form you will receive a reference number.
*Please note: If a form is not submitted by the deadline, you will remain enrolled in and billed for the Student Health Insurance Plan for the entire policy year.
The deadline for enrollment/waiver form submission has been extended to August 31, 2021.
Questions? Contact Gallagher Student Health & Special Risk toll free at 844-329-1588 or by going to our website and clicking on the Customer Service link.