UC SHIP Benefits - Medical

2023-24 Academic Year

UC SHIP Medical Benefits are administered by Anthem Blue Cross. Below is a brief summary of the current UC SHIP medical benefits for services with an in-network provider with Anthem Blue Cross.

A more detailed benefit description is available in the UC SHIP Benefits Booklet, including out of network benefit costs.

All services provided at the Student Health and Wellness Center, with the exceptions of optical and pharmacy services, are covered at 100% by the plan for UC SHIP enrolled students.

General Information

Annual Deductible
$100

Annual Out of Pocket Maximum
$1,500

Overall Lifetime Benefit Limit
Unlimited

Emergency Services

Emergency Room Services
$75 copay per visit - waived if admitted to the hospital

Urgent Care Services
$25 copay per visit

Ambulance Services
Covered in Full

Mental Health / Substance Abuse Services

Office visit Copay
$0 per visit

Inpatient Services
20% co-insurance after annual deductible satisfied

Substance Abuse Services
20% co-insurance after annual deductible satisfied

Psycho-Educational Testing
Covered in Full after $100 annual deductible has been satisfied. Plan has a $4,500 lifetime benefit for these services. Any billed amount above $4,500 will be the responsibility of the student.

Inpatient/Outpatient Services

Office Visit Copay (Primary Care/Specialty)
$15

Preventative Services - (Physical Exams/Immunizations)
Covered in Full

Hospitalization
20% co-insurance - after $100 annual deductible has been satisfied

Lab Tests
$0 copay per lab test

Acupuncture/Chiropractic Services/Physical Therapy
$20 copay per visit

Durable Medical Equipment (In-Network)
No deductible, copay, or co-insurance

Imaging Services

X-Ray
$0 copay

Ultrasound
Covered in Full

MRI / CT Scan / PET Scan
$25 copay

How To Find A Provider

Glossary of Insurance Terms

Copay
The flat fee you pay for covered services, usually due at the time you receive care. For example, you might pay a $15 copay to see a primary care doctor or specialist.
Co-insurance
The slice of a medical service you’re responsible for. For example, you might pay 20% of the cost for a particular service, and the insurance company or plan will pick up the tab for the remaining 80%.
Annual Deductible
The amount you have to pay toward medical costs before UC SHIP starts paying part of the bill.
Emergency
An illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm or death.
Maximum Allowed Amount
The total reimbursement payable under your plan for covered services you receive from in-network and out-of-network providers. It is the claims administrator’s payment toward the services billed by your provider, combined with any deductible or coinsurance you may owe. If you receive services from an out-of-network provider, the provider will bill you the difference, if any, between their charges and the maximum allowed amount.
Maximum Out of Pocket
The maximum amount of money you’ll have to pay for health care in a year. After you meet the maximum, UC SHIP covers 100% of all eligible costs for the rest of the plan year.
In-Network
A group of healthcare providers and facilities—including doctors, hospitals, and labs—that contract with your healthcare plan to provide services at negotiated discount rates. You’ll usually pay less when you use a network healthcare provider. UC SHIP contracts with Anthem Blue Cross to provide access to its extensive network of hospitals and providers, including UC Family facilities and provider groups.
Out of Network
Health care professionals, hospitals, clinics, and labs that do not belong to the Anthem Blue Cross Prudent Buyer network. You’ll typically pay more and may need to file a claim for payment.
Customary and Reasonable
A Customary and Reasonable charge, as determined annually by Anthem Blue Cross, is a charge which falls within the common range of fees billed by a majority of physicians for a procedure in a given geographic region, or which is justified based on the complexity or the severity of treatment for a specific case. When a non-Anthem Blue Cross physician is used, the patient is responsible for payment of all charges in excess of the Anthem Blue Cross C&R payment.
Referral
Written authorization given by the student health center (SHC) to seek care outside of the SHC for medically necessary services.