Students

 

Benefits for UC Berkeley Students 2012-2013:

UC SHIP 2012-13

As a registered student at Cal, you have an outstanding health plan available designed specifically for college students.

The UC Student Health Insurance Plan (UC SHIP) is a comprehensive major medical insurance plan, providing medical, counseling, prescription, vision and dental services. Remember, all students can use the Tang Center, whether you have UC SHIP or not.

Important -Please Note:

  • UC SHIP coverage period: Fall August 15-January14, Spring January 15-August 14
  • All care must begin at University Health Services. With the exception of emergency or urgent care, 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 some medical services provided outside of UHS. Services that require the deductible are noted below.
  • If providers or facilities are used that are not part of the Anthem Blue Cross Prudent Buyer Provider Network, claims will be paid at 60% of the non-Network rate (customary and reasonable), which is often significantly lower than the Network rate. For example, 90% 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 for in-network services (excluding deductibles, Pharmacy co-payments, and other co-payments such as office visits), 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.
  • UC SHIP has a $400,000 lifetime maximum.
  • Dependent plans are available for spouses and/or children of UC Berkeley students; more details will be available soon.

 

 

 

 

 

UC SHIP Premium
  Semester Annual
Graduate Students $1153 $2306
Undergraduate Students $891 $1782
24/7 Advice Nurse Line
  • Weekday UHS Advice Nurse: During weekday hours, students can call the UHS Advice Nurse line to speak with one of our nurses by calling 510/643-7197.
  • UC SHIP After Hours Nurseline: 24/7 access to Anthem Blue Cross nurseline at 877-351-3457.
Inpatient Hospital Services
Including:
 Medical Services
Mental Health
Maternity Services
Service Coverage
Semi-Private Room Pays 90% of Anthem Blue Cross Network rates,
60% of non-Network rates
Lab Tests, X-rays & Imaging Pays 90% of Anthem Blue Cross Network rates,
60% of non-Network rates
General supplies Pays 90% of Anthem Blue Cross Network rates,
60% of non-Network rates
Nursing services Pays 90% of Anthem Blue Cross Network rates,
60% of non-Network rates
Medication Pays 90% of Anthem Blue Cross Network rates,
60% of non-Network rates
Physicians & Specialists Pays 90% of Anthem Blue Cross Network rates,
60% of non-Network rates
Transgender surgery Pays 90% of Anthem Blue Cross Network rates,
non-Network providers are not covered
Inpatient surgery Pays 90% of Anthem Blue Cross Network rates,
60% of non-Network rates
  • Inpatient hospital services are subject to the deductible.
  • 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 30 days from date of birth at 90% in network, or 60% non-network, up to a $25,000 lifetime maximum unless enrolled as a dependent.
  • Non-network hospital penalty: covered expenses will be reduced by 25% for services and supplies provided by a non-contracting hospital, except in cases of emergency admission.
   
Emergency Room Services (authorization is not required)
  • Emergency Room: Pays 100% after $100 co-pay (co-pay waived if admitted) of Anthem Blue Cross Network rates for treatment provided within 72 hours for injuries or sudden and serious illness, as determined by Anthem Blue Cross. Includes facility and professional services.
  • Attending physicians: Pays 100% of Blue Cross Network rate or 60% of non-Network rate.
   
Outpatient Services
Service Coverage
Medical Office Visit At University Health Services:
$15 co-pay for Primary Care, $20 co-pay for Specialists (authorization required)

Outside of University Health Services
(An authorization by a UHS Clinician is required prior to seeking services outside of Tang or your claims will be denied):
Pays 100% after $15 co-pay for primary care, $20 co-pay for specialty care from Anthem Blue Cross Network providers, not subject to the deductible. Plan pays 60% of the allowable non-Network rates, subject to deductible.
Adult Preventative Services Adult preventative services at University Health Services (including routine mammograms, Pap smears & prostate cancer screenings) covered at 100%. One per plan year. This benefit is not covered outside UHS.
Lab Tests, X-rays, Imaging, Mammograms At University Health Services:
Pays 90% of UHS rates

Outside of University Health Services:
(An authorization by a UHS Clinician is required prior to seeking services outside of Tang or your claims will be denied)
Pays 90% of Anthem Blue Cross Network rates, or 60% of non-Network rates.
Mental Health Office Visits At University Health Services:
After five free counseling visits, pays 100% after $15 co-pay; psychiatry visits pays 100% after $15 co-pay

Outside of University Health Services
(An authorization by a UHS Clinician is required prior to seeking services outside of Tang or your claims will be denied):
Pays 100% after $15 copay for Anthem Blue Cross Network providers, not subject to the deductible. Plan pays 60% of non-Network rates, subject to deductible.
Maternity/Prenatal Care/Abortion Prenatal: $15 co-pay (deductible waived) for first visit; 100% covered for subsequent visits in-network.
Maternity: 90% in-Network; 60% non-Network
Abortion: 90% in-Network; 60% non-Network
Acupuncture Pays 100% after $20 co-pay (deductible waived) up to 20 visits a year (20 visit maximum is combined with chiropractic and spinal manipulation.)

An authorization by a UHS Clinician is required prior to seeking services outside of Tang or your claims will be denied.

Chiropractic Services Pays 100% after $20 co-pay (deductible waived) up to a maximum of 20 visits a year (20 visit maximum is combined with acupuncture and osteopathic manipulation.)

An authorization by a UHS Clinician is required prior to seeking services outside of Tang or your claims will be denied.

Podiatric Services Pays 90% Anthem Blue Cross Network rates, or 60% of non-Network rate.

An authorization by a UHS Clinician is required prior to seeking services outside of Tang or your claims will be denied.

Home Health Visits Pays 100% in Anthem Blue Cross Network; 60% of non-Network rates, up to 100 visits per plan year.
Physical Therapy, Physical Medicine, Occupational
Therapy and Speech Therapy		 Pays 100% after $20 co-pay (deductible waived) for services at University Health Services or with an Anthem Blue Cross network provider. Pays 60% for non-Network provider (subject to deductible). This benefit has a $5,000 maximum.

An authorization by a UHS Clinician is required prior to seeking services outside of Tang or your claims will be denied.
Prescription Drugs At University Health Services:
Prescriptions filled at the UHS Pharmacy have a $5 co-pay for generic and $25 co-pay for brand name medications (30-day supply). New for 2012-13, birth control will be covered at 100%; some conditions apply.

Outside of University Health Services:
Prescriptions filled outside of UHS have a $5 co-pay for generic and $25 co-pay for brand name medications (30-day supply), $40 for "non-formulary" items. Please note, Walgreens is no longer a network pharmacy for UC SHIP as of January 1, 2012.

No prescription medications are subject to the deductible. The pharmacy benefit is limited to a maximum of $10,000 coverage per plan year.
Allergy Testing & Injections Pays 90% of Anthem Blue Cross Network rates, 60% of non-Network rates
Dental Care UC SHIP members receive dental coverage through Delta Dental. See Dental Coverage 2011-12.
Dental Injury Pays 90% of Anthem Blue Cross Network rates for injury to natural teeth.
Ambulance - Ground Pays 90% of customary and reasonable charges if patient receives emergency care or is hospitalized.
Ambulance - Air Pays 100% of customary and reasonable charges, if patient receives emergency treatment or is hospitalized; up to a maximum of $25,000 per plan year.
Urgent Care At University Health Services:
$30 co-pay for Urgent Care clinic visit

Outside of University Health Services:
 Pays 100% after $50 co-pay for Anthem Blue Cross Network provider, not subject to the deductible. Plan pays 60% of non-Network rates (subject to deductible).
Skilled Nursing Facility Pays 90% 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 90% of rental or purchase of medical equipment and supplies that are ordered by a Physician and are of no further use when medical need ends, when obtained
from a durable medical equipment supplier, including rental or purchase of diabetic equipment and supplies (excluding insulin) up to a maximum of $5,000 per plan year.
Immunizations

(routine immunizations are recommended to be administered at UHS)

 Pays 100% of University Health Services charges or Anthem Blue Cross Network rates, or 60% of non-Network rates, for the following immunizations:
Diphtheria/Tetanus/ Pertussis, Measles, Mumps and Rubella; Meningococcal; Varicella; Influenza; Hepatitis A and Hepatitis B; Pneumococcal; Polio; and Human Papillomavirus. New for 2012-13: TB testing/screening now covered 100%, no matter what the reason. Routine immunizations are recommended to be administered at UHS.

All other immunizations covered at 90% of charge at University Health Services or 90% of Anthem Blue Cross Network rates or 60% of non-Network rates.
Medical Evacuation 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 die while enrolled in UC SHIP, the plan pays necessary expenses up to $7,500 to prepare your remains and transport your body to your home country.
Vision Care Vision Care is provided through Anthem Blue View Vision-Insight Plan, available at both UC Berkeley School of Optometry clinics on campus (Tang Center and Minor Hall). See vision benefits here.

Glossary of Insurance Terms
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