Students

How to Use the UC Student Health Insurance Plan

UC SHIP 2012-13

 

Know how UC SHIP works! Here are the basics to get you started:

When you need health care:
 With UC SHIP, all care must begin at University Health Services (UHS) - Tang Center.** When you need medical care, simply call to make an appointment.UC SHIP members pay $15 for a Primary Care office visit and $30 for an Urgent Care clinic visit at the Tang Center. For most other services, SHIP members pay 10% of UC UHS fees. There are no claims to file for UHS visits.

**Don't get stuck with the bill! An authorization by a UHS Clinician is required prior to seeking services outside of Tang or your claims will be denied. Qualified Emergency Room or Urgent Care visits are the only exception.

Referrals from UHS clinicians If you need services at another health care facility or physician's office, your UHS clinician will make the referral. You must have outside appointments pre-authorized by the Insurance Office**. Off-campus care (care outside of the Tang Center) is coordinated by UHS clinicians, and the UC SHIP staff will provide authorizations for covered services and ensure that your claims are handled accurately.

For off-campus care, UC SHIP contracts with Anthem Blue Cross to provide medical and mental health services through their extensive network of hospitals and providers. If providers or facilities are used that are not part of the Anthem Blue Cross Prudent Buyer Provider Network, your claims will be paid at a percentage of the "limited fee schedule," which is often significantly lower than the network rate. See SHIP and Anthem Blue Cross - What's the Connection? for explanation.

To find an Anthem Blue Cross Prudent Buyer provider you can call the customer service number on the back of your health insurance card, or go to the Anthem Blue Cross web site.

**Don't get stuck with the bill! An authorization by a UHS Clinician is required prior to seeking services outside of Tang or your claims will be denied. Qualified Emergency Room visits are the only exception.

When you are out of the Bay Area and need care If you are out of the area and require care that is of medical necessity please contact the Student Health Insurance Office at (510) 642-5700 for authorization. UC SHIP covers authorized medically indicated care worldwide (See BlueCard® Worldwide website or Using UC SHIP Abroad [PDF]).
Emergency care No authorization from the Student Health Insurance Office is required for visits to an emergency room or urgent care centers. Please provide the facility with your Anthem Blue Cross card. Claims submitted to Anthem Blue Cross will be processed according to the UC SHIP benefits.

All follow-up care must be authorized in advance by the Student Health Insurance Office.
Pre-existing conditions UC SHIP does not exclude pre-existing conditions. There is no waiting period for coverage for pre-existing conditions.
Authorization for Services Most non-emergency services provided outside of UHS must receive prior authorization or your claim may not be paid.

Services outside UHS that do not require pre-authorization include:

For all other non-emergency medical care outside UHS, bring medical referrals to Student Health Insurance Office, Room 3200, Tang Center or call (510)642-5700 for UHS pre-authorization.

Billing for services at UHS UC SHIP members do not file a claim for services at UHS that have fees. At the time of service, patients will pay only the fees for which they are responsible, usually 10% of the total charges. UHS will then file a claim with UC SHIP for payment of the remainder of the charges.
Billing for services outside UHS When students receive care outside of the Tang Center, the health care provider may require payment of the student's portion of fees at the time of service, or they may send a bill after UC SHIP has paid the covered amount. Most providers will submit bills directly to Anthem Blue Cross. If you receive a medical bill and the provider has not billed Anthem for services, please call the number on the bill and give them your Anthem 800 ID number and ask them to re-bill the claim directly to Anthem. If you don’t have your Anthem ID card or don’t have your 800 #, call Student Health Insurance Office at (510)642-5700 to obtain your number. Claims must be submitted within 12 months of the date of service.

Anthem Blue Cross is a member of the BlueCross BlueShield Association, which coordinates member claims through its BlueCard® Program.

For out of state claims: when you are outside of California and receive health care services, you should request that your provider bill the local Blue Cross - Blue Shield company in that state to ensure your services are covered according to your SHIP benefits.
For out of country claims: be sure to obtain a bill that contains all of the information listed below. For convenience, you can print and use an "international claim form" from the BlueCard® Worldwide website. See Using UC SHIP Abroad (PDF).

To ensure proper payment or reimbursement of your claim, make sure you get an itemized bill from the provider. An itemized bill includes:

    1. Provider's name, address, and tax identification number. Individual providers must also include their professional license number.
    2. Patient's name, address, date of birth, and your Anthem Blue Cross customer number (800-XXX-XXX -also located on the back of your Anthem Blue Cross insurance card).
    3. Dates of service.
    4. Procedure codes for services rendered
    5. Charges for each service.
    6. Date of injury and description of how the injury occurred, if the claim is for treatment of an injury. This is especially important on claims for dental injury.

If any of this information is not included on a claim, the insurance payment may be delayed or denied. Most providers are aware of what is required for processing an insurance claim and will be happy to exchange an incomplete bill with one containing all of the required information.

For prescriptions filled outside of UHS, you should receive what most pharmacies refer to as an "insurance company receipt." If not, ask the pharmacist or clerk for one before you leave the store.

To file a claim:

    1. Obtain a claim reimbursement label from the Tang Information Center, located in the lobby.
    2. Complete the label as directed in the instructions provided and attach it to the itemized bill or prescription receipt.
    3. Place the bill/receipt with the completed label in the drop box at the Tang Information Center.

Expect to receive an Explanation of Benefits from Anthem Blue Cross within six weeks. If you have not received an Explanation of Benefits after six weeks, feel free to call the Student Health Insurance Office at 510-642-5700 for assistance. You may also call Anthem Blue Cross directly at 866-940-8306.

Remember: It is very important that you keep your address updated with Tele-Bears or Bear Facts. This is how Anthem Blue Cross knows your address for reimbursement. When you move or go away for the summer, please remember to update your address.
Deductibles There is a $200 plan year deductible for some services provided outside UHS. UC SHIP members are responsible for the first $200 of qualified charges outside of UHS each plan year. Once the deductible has been satisfied, SHIP benefits begin. Medical and mental health office visits, emergency room visits, urgent care center visits and prescriptions are not subject to the annual deductible. 

Amounts over the "limited fee schedule" as determined by Anthem Blue Cross do not accumulate toward the deductible.
Dual coverage Services provided at UHS will be billed exclusively to SHIP regardless of whether you have dual coverage through another plan in addition to SHIP. For services provided outside of UHS, UC SHIP is secondary to all other insurance plans (except Medi-Cal and Tricare), meaning the other plan must pay for services first. In this case, UC SHIP will cover any charges, within the plan's benefit limits, not covered by your other plan. In order to coordinate coverage and payment, Anthem Blue Cross may ask you for information about your other plan. Claims must be processed by your “primary “ health pan, before Anthem Blue Cross can “coordinate benefits”. An authorization from the Tang Center is required as well.

Important Reminder: UC SHIP is primary in all cases if you have MediCal or Tricare.
Annual out-of-pocket maximum 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 (excluding Pharmacy co-payments) to in-network providers, 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), out of network providers, or to services not covered by the plan.
Lifetime maximum UC SHIP has a $400,000 lifetime maximum.
Managing your plan Updated address: It is very important that you keep your address updated with Tele-Bears or Bear Facts. This is how Anthem Blue Cross knows your address. When you move or go away for the summer, please remember to update your address.

Insurance card: See SHIP FAQ.

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