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Benefits for UC Berkeley Students 2008-2009:
Click here for benefits for
2009-2010.
Services and Supplies covered by SHIP:
Important -
Please Note: |
- All care must begin at University Health Services. All services
must be authorized by the Student Health Insurance Office in
order to ensure payment for services.
- There is a $200 per plan year deductible for medical services
provided outside of UHS. The deductible applies to all services
described below except where noted.
- If providers or facilities are used that are not part of the
Blue Cross Prudent Buyer Provider Network, claims will be paid
at 60% of the non-Network rate (limited fee schedule), which
is often significantly lower than the Network rate. For example,
80% coverage of the Network rate is going to be less costly
to the patient than 60% coverage of the non-Network rate.
- Students are responsible for no more than $3,000 of out-of-pocket
expenses each plan year. If you have paid $3,000 in co-insurance
and deductibles (not including Pharmacy co-payments), you will
no longer be required to pay co-insurance for the remainder
of the plan year. The out-of-pocket maximum does not apply to
amounts exceeding stated benefit limits (for example, Pharmacy
or Physical Therapy limits) or to services not covered by the
plan.
- SHIP has a $400,000 lifetime maximum.
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Inpatient
Hospital Services
Including:
Medical Services
Mental Health
Maternity Services |
| Semi-Private Room |
Pays 90% of Blue Cross Network rates,
80% of non-Network rates
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| Lab Tests, X-rays & Imaging |
Pays 90% of Blue Cross Network rates,
80% of non-Network rates |
| General supplies |
Pays 90% of Blue Cross Network rates,
80% of non-Network rates |
| Nursing services |
Pays 90% of Blue Cross Network rates,
80% of non-Network rates |
| Medication |
Pays 90% of Blue Cross Network rates,
80% of non-Network rates |
| Physicians & Specialists |
Pays 80% of Blue Cross Network rates,
60% of non-Network rates |
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- Inpatient hospital care in connection with childbirth will
be covered for at least 48 hours following a normal delivery
(96 hours following a cesarean section).
- Newborns are covered for the first thirty days from date of
birth, with a $25,000.00 lifetime maximum.
- Coverage of mental health inpatient treatment is limited to
30 days per year, except as medically indicated for severe conditions
covered by the Mental Health Parity Act of 2000.
- Coverage of inpatient hospital alcohol and drug detoxification
treatment is limited to 4 days per plan year.
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| Emergency
Room Services |
- Emergency Room: Pays 100% of Blue Cross Network rates
for treatment provided within 72 hours for injuries or sudden
and serious illness, as determined by Blue Cross. Pays 80% of
Blue Cross Network rates, or 60% of non-Network rates, for all
other conditions.
- Attending physicians and ancillary services: Pays 80%
of Blue Cross Network rate or 60% of non-Network rate.
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| Outpatient
Services |
| Physician office visits |
Pays 80% of Blue Cross Network rates, or 60%
of non-Network rates |
| Lab Tests, X-rays, Imaging, Mammograms |
Pays 80% of Blue Cross Network rates, or 60% of non-Network
rates |
| Maternity/Prenatal Care/Abortion |
Pays 80% of Blue Cross Network rates, or 60% of non-Network
rates |
| Mental Health |
Pays 80% of Blue Cross Network rates, or 60% of non-Network
rates, for outpatient psychotherapy. For conditions not
covered by the Mental Health Parity Act of 2000, covers
a maximum of up to 25 visits per plan year, and visits are
not subject to the deductible.
For psychological testing, medication monitoring, psychotherapy
services and other conditions covered by the Mental Health
Parity Act of 2000, pays 80% of Blue Cross Network rates,
or 60% of non-Network rates. These services are subject
to the deductible.
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| Acupuncture |
Pays $25.00 per visit per day up to a maximum of $100.00
per plan year |
| Chiropractic services |
Pays $25.00 per visit per day up to a maximum of $100.00
per plan year |
| Podiatric services |
Pays 805 of charge up to a maximum of $125.00 per plan year |
| Home Health visits |
Pays 100% of Blue Cross Network rates, or 80% of non-Network
rates, up to 100 visits per plan year |
| Physical Therapy |
Pays 80% of Blue Cross Network rates, or 60% of non-Network,
up to $1,000 per plan year |
| Prescription Drugs |
Prescriptions filled at the UHS-Tang Center
Pharmacy have a co-pay of $15 for generic and $25 for brand
name medications (30-day supply). Hormonal contraceptives
have a co-pay of $25 for 3 cycles.
Prescriptions filled outside of the Tang Center are reimbursed
at 70% of billed charges.
No prescription medications are subject to the deductible.
The pharmacy benefit is limited to a maximum of $5,000 coverage
per plan year. See SHIP
Pharmacy Benefits - Tracking How Much You've Used.
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| Allergy Testing & Injections |
Pays 80% of Blue Cross Network rates, or 60% of non-Network
rates, up to $1,000.00 maximum per plan year |
| Dental Care |
SHIP members receive dental coverage through MetLife. See
Dental Coverage. |
| Dental Injury |
Pays 80% of Blue Cross Network rates, or 60% of non-Network
rates, for injury to natural teeth, up to $300.00 per injury,
for services within 90 days of the date of injury |
| Ground Ambulance |
Pays 100% of customary and reasonable charges, up to $1,000
maximum per trip, if patient receives emergency treatment
or is hospitalized |
| Air Ambulance |
Pays 80% of customary and reasonable charges
if patient receives emergency treatment or is hospitalized |
| Hospice Care |
Pays up to $5,000 maximum for patient's lifetime |
| Skilled Nursing Facility |
Pays 80% of Blue Cross Network rates, or 60% of non-Network
rates, up to a maximum of 100 days per plan year |
| Durable Medical Equipment |
Pays 80% of rental or purchase of medical equipment and
supplies which are ordered by a Physician and are of no further
use when medical needs ends, when obtained from a durable
medical equipment supplier, including rental or purchase of
diabetic equipment and supplies (excluding insulin). |
| Immunizations |
Pays 80% of Blue Cross Network rates, or 60% of non-Network
rates, for the following immunizations:
Diphtheria/Tetanus/Pertussis
Measles, Mumps and Rubella
Varicella
Influenza
Hepatitis A and Hepatitis B
Pneumococcal
Meningococcal
Polio
Human Papillomavirus
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| Medical Evacuation |
If you are in the U.S. on a non-immigrant visa and become
unable to continue your academic program because of your medical
condition, the plan pays necessary expenses up to $10,000
for return to your home country when prior authorization has
determined medical necessity. |
| Repatriation |
If you are in the U.S. on a non-immigrant visa and die
while enrolled in SHIP, the plan pays necessary expenses
up to $7,500 to prepare your remains and transport your
body to your home country.
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| Vision Care |
Vision Care is provided through the UC Berkeley School
of Optometry, at two clinics on campus and 11 other locations
throughout California. Benefits include:
- Annual comprehensive eye exam - $5 copay.
- $15 copay for spectacle frames and lenses OR contact
lenses, once every
12 months, up to $120 value.
- Refractive Surgery (Lasik, PRK) - 50% discount.
- 24-hour emergency phone assistance.
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