Questions and Answers for Parents About Health Insurance

1. What must my son or daughter do in order to be sure that the university will pay for his or her medical care related to an eligible athletic injury?
2. What will the university's athletic insurance cover?
3. I understand that my son or daughter needs to be covered by an additional health insurance plan. Won't the athletic insurance policy cover him or her without one?
4. How can my son or daughter meet the major medical insurance requirement if he or she is not covered by a parent's policy?
5. What are the advantages of carrying SHIP insurance?
6. How can my son or daughter waive enrollment in SHIP?
7. What should my son or daughter know about his or health insurance plan?
8. What can I do to speed up processing of medical claims?
9. What should I do if I receive a bill for medical services or have any questions about the athletic Health Insurance Program?

Answers

1. What must my son or daughter do in order to be sure that the university will pay for his or her medical care related to an eligible athletic injury?
   To ensure coverage, all services must be coordinated and approved by the university's sports medicine staff. Your son or daughter should contact a staff athletic trainer in order to begin this process. In the case of an emergency, your son or daughter should go directly to the nearest emergency room, and then contact a staff athletic trainer as soon as possible afterwards. Please note that, except in an emergency, we cannot cover medical services that have not received prior authorization by our sports medicine staff.
   
   
2. What will the university's athletic insurance cover?
   The University athletic insurance can cover medical services that have been pre-authorized and are related to injuries sustained during a scheduled game, competition or practice. We cannot cover injuries or illnesses unrelated to participation in our programs, nor can we cover injuries that occured before your son or daughter began participation in our programs.
   
   Also note that the university's athletic program provides "excess-only" coverage. This means our insurance policy can only pay for a medical service after the bill for that service has been submitted to and considered by the other insurance policy that covers the student. Once all other insurance policies have paid or denied the claims for an eligible athletic injury, we are generally able to pay 100% of the co-payments and deductibles from other policies.
   
   
3. I understand that my son or daughter needs to be covered by an additional health insurance plan. Won't the athletic insurance policy cover him or her without one?
   As a condition of enrollment, the university requires that all students be covered by a major medical health insurance plan. The athletic program is only able to cover authorized treatment of sports injuries sustained while participating in our programs. The major medical insurance covers your student for illnesses and injuries that are not related to athletic participation.
   
   
4. How can my son or daughter meet the major medical insurance requirement if he or she is not covered by a parent's policy?
   All students at Berkeley automatically are enrolled in the UC Berkeley Student Health/Dental Insurance Plan (SHIP) unless a waiver form is filed by the July 15 deadline indicating that he or she is covered by another comparable insurance plan. A charge for SHIP will appear on his or her E-Bill each semester. For more information see the SHIP pages on this web site or call (510) 642-5700.
   
   
5. What are the advantages of carrying SHIP insurance?
   SHIP is affordable and convenient, and works in conjunction with the primary health care provided to all students at University Health Services at the Tang Center. (More information about UHS). If there is a fee for a service at University Health Services, students with SHIP pay only 20% of costs, with UHS billing SHIP for the rest. If labs or tests are needed, it can sometimes be difficult to obtain prompt care through private insurance. For example, if your son or daughter needs lab tests drawn, he or she could conveniently do this at UHS rather than going to an outside lab as dictated by private insurance. SHIP also provides emergency and hospital coverage, 80% coverage for specialist referrals (many of whom come to UHS to see students), mental health coverage, and a $2,000 annual prescription allowance. Finally, and very important, many insurance carriers do not have adequate coverage for non-emergency care when a student is away from home. SHIP members are backed by the Blue Cross network of providers and are covered for pre-authorized non-emergency care nationally and internationally.
   
   
6. How can my son or daughter waive enrollment in SHIP?
   You can download the SHIP waiver form beginning April 15, 2007. If your son or daughter is covered under another health insurance plan, your son or daughter can fill out and return the form in order to be waived from SHIP. The student must file a new waiver each year. The SHIP office at (510) 642-5700 can answer any questions about the health insurance waiver program.
   
   

7. What should my son or daughter know about his or her health insurance plan?
   Whether your son or daughter is covered by SHIP or by a private insurer, it is important that your student knows what he or she needs to do in order to get medical care. Below is a list of things to discuss with your son or daughter. Your health insurance plan's customer service department should be able to provide you with this information.
   
   a) Does your plan require pre-authorization of services?
       Many plans require that you get pre-authorization for any service in order for it to
       be covered. It is important that your son or daughter knows who to call for pre-
       authorization.
   
   b) Does your plan restrict what doctors or providers your son or daughter sees?
       Most plans only pay their highest level of benefits when you see doctors who are
       affiliated with their plan. Some, such as Kaiser, will only cover services provided in
       their own facility. It is important that your son or daughter know whom he or she
       can see for services.
   
       Many Health Maintenance Organizations (HMOs) require that their members begin all non-emergency service with a designated "Primary Care Physician" (PCP). If the PCP is not located in the Bay Area, it can sometimes be difficult for a student to get care. We strongly advise switching to a physician near the Berkeley campus.See local provider list for suggestions.
   
   c) Does your son or daughter's eligibility for coverage end at a certain age?
       Most students lose their eligibility to be a dependent on their parent's plans at age
       23 or earlier. If your son or daughter is dropped from your coverage, he or she
       must join SHIP within 30 days of losing private coverage. Contact the SHIP office
       at (510) 642-5700 for information about enrolling in SHIP in this situation.
   
       Your health insurance plan may require that you send them verification of your son
       or daughter's enrollment at Berkeley. This verification can be obtained from the
       Office of the Registrar at (510) 642-1883.
   
   d) Does your health plan provide its member with an identification card?
       Virtually all health insurance plans provide their members with identification cards.
       To be prepared for a medical emergency, it is very important that your son or
       daughter carry their insurance identification card at all times.
   
   

8. What can I do to speed up processing of medical claims?
   In addition to making sure that your son or daughter understands his or her health insurance, it is also important that you provide us with information about this insurance. Please take the time to fill out the Health History forms and return them to our office before the pre-participation physical. We must receive this form in order for your son or daughter to participate in our athletic programs. You will be asked to complete a copy of this form each year to ensure that information available to the Sports Medicine staff is current.
   
   
9. What should I do if I receive a bill for medical services or have any questions about the Athletic Health Insurance Program?
   For questions about billing or insurance coverage, please contact:
   
   Dan Westbrook
   Athletic Billing Coordinator
   2222 Bancroft Way Room 3200
   Berkeley, CA 94720-4300
   Phone: (510) 642-8640
   Fax: (510) 642-9119
   
   For questions about authorizations or medical care, please contact:
   
   Cal Sports Medicine
   Administrative Assistant
   2222 Bancroft Way
   Berkeley, CA 94720-4300
   Phone: (510) 643-4801
   Fax: (510) 643-9790
   

This page provides general information. Complete descriptions of the athletic insurance and SHIP programs are on file in the Student Health Insurance Office.

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