UC
STUDENT
HEALTH
INSURANCE
PLAN
UC IRVINE
GRADUATE STUDENTS
2013–2014
Your SHC clinician will provide you with a REFERRAL to visit a provider outside the SHC if you need a specialist or surgery. This is when the Anthem PPO plan is used *
If you need health care, visit the SHC first, right on campus. Make an appointment with a primary care clinician
START YOUR CARE AT THE
SHC
Emergency care or urgent care clinic visits when the SHC is closed: No REFERRAL is needed
RUSH TO EMERGENCY CARE
EXCEPTION
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To keep your expenses low, go to an Anthem Network Provider when you receive your REFERRAL
KEEP YOUR COSTS LOW
NEED A REFERRAL?
If you have questions, your SHC staff can assist you. You can also call Anthem Customer Service at (866) 940-8306 or log in to Anthem.com/ca
SHC
STAFF CAN HELP
IS EASY!
CONVENIENT,
AFFORDABLE,
CARING
Ways to Make the Most of the
Student Health Center (SHC) & the
UC Student Health Insurance Plan (UC SHIP)
Schedule a free wellness physical.Allyouhaveto doismaketheappointment.UCleadsthewayinfree preventivecare.
Quit that bad habit.Findresourcesthatwill helpyouunderstandandmakechanges. Managestress.Loseweight.Eatright.Sleep. Stopsmoking.
Talk over what’s worrying you.Inasafespace,with someonewhoknowswhatit’sliketostruggleand willlistencarefullytoyou.
Get your shots.Conveniencewhenyouneedit. Manypreventiveimmunizationsarefree.
See better.(Itmighthelpyourgrades!)Withthis coverage,payaslittleas$10foraneyeexam.Saveon glassesandcontactlenses,too.
Have your teeth checked.Dentalcareisanoption youdon’twanttopassup.Chooseanetworkdentist andyoursix-monthcheck-upisfreewhenyouhave thiscoverage.
Learn how to save on health care costs.Callon expertsattheSHCtoguideyouthroughtheworld ofcopayments,deductiblesandcoinsurance.They actuallylikethisstuff.
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TABLE OF CONTENTS
Ataglance. . . 6 Welcometoyourhealthhome. . . 7 Keeptrackofyoureligibility. . . 13 Healthyuserguide. . . 19 Wiseuserguide. . . 37 Yourdentalcoverage. . . 45 Yourvisioncarecoverage. . . .49 OptionalUCSHIPbenefitsfordependents. . . 53 Definitionsofinsuranceterms. . . 58 HowtogetintouchwiththeSHC,UCSHIPand yourinsurancecarriers . . . 59FAQs
How do I enroll in UC SHIP?
Allfull-timeregisteredgraduatestudentswithaGSHIPfee assessed,includingregisteredinternationalstudentsand registeredin-absentiastudents,areautomaticallyenrolled inUCSHIPandchargedahealthinsurancepremium ontheirregistrationbillunlesstheysuccessfullywaive coverage.Registeredgraduatestudentscoveredunder UCSHIPmayelecttocovertheireligibledependents.For moreinformation,includinganexplanationofhowtowaive coverage,seethesectionofthisbrochurecalled“Keep trackofyoureligibility.”
What kinds of care does the SHC offer?
TheSHCisanoutpatienthealthcenterthatprovideson-campusmedical,behavioralhealthandpreventivecare.
UC SHIP Health Card Logo 4/22/13
UC STUDENT
HEALTH INSURANCE
PLAN (UC SHIP)
AT A GLANCE
what uc ship covers for graduate students
TheSHCandUCSHIPworktogethertomakeyour healthcarechoicesaffordableandworryfreewhile youareastudent.UCSHIPisastate-of-the-art, comprehensivehealthcareplandesignedtocomply withtheAffordableCareAct(ACA.
uc ship medical coverage
• Automaticforallregisteredgraduatestudents withoptionforwaiver • GivesUCIrvinegraduatestudentsaccessto qualityhealthcare • ConsiderstheSHCyourhealthhome • Offerscomprehensivepreventivecareforfree attheSHC • RefersyoutoanAnthemBlueCross–managed networkofhealthcareprovidersoutsideoftheSHC • EnsuresthatUCSHIPmembershavecoveragefor emergencyandauthorizednon-emergencymedical care24/7anywhereintheworld
uc ship dental coverage
ProvidesaPPOdentalplanthatcoversnetworkand non-networkservices
uc ship vision coverage
Coversroutineeyeexams,eyeglassesandcontactlenses offeredbynetworkandnon-networkproviders
WELCOME
TOYOUR
HEALTH
HOME
INFO YOU’LL FIND IN THIS SECTION
YourhealthhomeistheSHC. . . 9 YouareautomaticallyenrolledinUCSHIP. . . 9 Youcanmakechoicesaboutyourcoverage. . . 9 HowtheSHCandUCSHIPworktogether. . . 10 Howlongcoveragelasts. . . 10 Preventivecareisfreeofcharge. . . 10 Well-womencareisfreeofcharge. . . 10 Everystudentshouldhaveaprimarycareclinician . . . .11 YouneedareferraltohaveUCSHIPpayyour medicalbenefits . . . .11 Ifyougotoaproviderwithareferral. . . .11 Caremustbeconsideredmedicallynecessary. . . 12 Youcancoverdependents . . . 12 Visionanddentalcoveragetoo. . . 12FAQs
How long am I covered with UC SHIP?
Coverageusuallybeginsatfalltermenrollmentand continuesthroughthesummeruntilthenextfallterm begins.Thereisnogapincoverageduringtermbreaks.
Do I need to be covered by UC SHIP to use the SHC?
No.AllregisteredstudentscanusetheSHC,nomatter whatkindofmedicalinsurancetheyhave.
YOUR HEALTH HOME IS THE SHC TheSHCisanoutpatienthealthcenterthatprovideson-campusmedical,behavioralhealthandpreventivecare. TheSHCisstaffedbyboard-certifiedphysicians,nurse practitioners,physicianassistantsandnurseswhoare expertsinstudenthealthneeds. SHCcliniciansprovideprimarycareforUCSHIPmembersand coordinateanyneededadditionalcare.Allregisteredstudents mayusetheservicesoftheSHC,regardlessofwhattypeof medicalinsurancetheyhave.TheSHCdoesnotdirectlybill insuranceplansotherthanUCSHIP.StudentswhowaiveUC SHIPenrollmentareresponsibleforpaymentofSHCfees, ifany.VisittheSHCwebsiteatwww.shc.uci.eduformore informationonavailableservicesandfees.
YOU ARE AUTOMATICALLY ENROLLED IN UC SHIP
TheUniversityofCaliforniarequiresallstudentstohave majormedicalinsurance.ItprovidesUCSHIPtomeetthis requirement.UCSHIPisamajormedical,behavioralhealth, pharmacy,dentalandvisioncareplan.Itcovershospitalization, off-campusorout-of-areacarewhiletraveling,andsome specialtyservicesnotavailableattheSHC. AllregisteredgraduatestudentswithaGSHIPfee assessed,includingregisteredinternationalstudents andregisteredin-absentiastudents,areautomatically enrolledinUCSHIPandchargedahealthinsurance premiumontheirregistrationbill,exceptthosewho successfullywaivecoveragebecausetheirhealthinsurance meetstheuniversity’sinsurancerequirements.
YOU CAN MAKE CHOICES ABOUT YOUR COVERAGE
ThemandatorygraduateplanatUCIrvineincludesmedical, dentalandvisioncoverage. Studentswhohaveprivatehealthinsurancemayapply towaiveenrollmentinUCSHIP.However,privatehealth insuranceplansmustsatisfythecriteriaforrequiredhealth carecoverageestablishedbytheUniversityofCalifornia. MoststudentskeeptheirUCSHIPenrollmentbecause itisacomprehensiveandaffordableplanwithexcellent benefits.Aslongasstudentsareregisteredatthe UniversityofCalifornia,UCSHIPcoversthem12months ayearanywhereintheworld.
WELCOME TO YOUR HEALTH HOME
HOW THE SHC AND UC SHIP WORK TOGETHER TheSHCandUCSHIPworktogethertoprovide comprehensivemedicalcarethataddressesthediverse, individualneedsofourstudents.TheSHCisaconvenient healthhomewherecareandUCSHIPcoveragearehandled seamlessly. TheSHCmanagestheclaimssubmissionsforservices providedattheSHCforstudentscoveredbyUCSHIP.The SHChasinsuranceexpertstoworkwithstudentswhohave morecomplexmedicalneeds. WhenyouarecoveredbyUCSHIP,youmustfirstseeknon-emergencymedicalcareattheSHCbymeetingwithyour primarycareclinician.Ifneeded,SHCclinicianswillissue referralsforcareoutsideoftheSHC.Theinsuranceoffice staffwillhelpyoufindAnthemBlueCrossPrudentBuyer networkproviderssoyoucanpaylowerout-of-pocketfees.
HOW LONG COVERAGE LASTS
Coverageusuallybeginswhenfallclassesstartand continuesthroughthesummeruntilthenextfallterm begins.Yourcoveragepremiumsarepaidwithyourtuition billforeachsemesterorquarterintheschoolyear.
PREVENTIVE CARE IS FREE OF CHARGE
Theuniversitybelievesthatahealthylifestyleisessential forlearningandgrowingwhileatUCIrvine.Freeaccessto preventivecareisdesignedtokeepstudentshealthy,detect andtreatdiseaseearlyon,andmanagecareforanynewor chronicconditions. UChasledthewayinbroad,affordablepreventivecarefor students,offeringitbeforehealthcarereformmandated freepreventivecare.EventhoughUCisnotrequired tocomplywiththoseguidelines,wefeltthathavinga preventivecarefocustoourapproachtocarerepresented thehighstandardsthatareappropriateforourUCstudents. Accessingfreepreventivecarecouldn’tbeeasier—it’sright oncampusattheSHC.
WELL-WOMEN CARE IS FREE OF CHARGE
AttheSHC,youcanreceiveawiderangeofpreventive examsandcancerscreenings.UCSHIPcoversfreeFDA-approvedcontraceptionandmammogramsaswellas
breast-feedingsupport.Forcovereddependents,thereis freewell-childcarethroughAnthemBlueCrossnetwork physicians.Thesearejustafewexamplesofthecoverage weprovideforservicesandcareattunedtoawoman’s healthconcernsthroughoutherlifespan.
EVERY STUDENT SHOULD HAVE A PRIMARY CARE CLINICIAN Anongoingrelationshipwithaprimarycareclinicianisas importanttoyourtotalhealthasexercise.Therelationship willhelpensurethatyouruniquehealthcareneedsget closeattention.Makeanappointmentearlyinyourfirst yearoncampussoyoucanselectaproviderandreceive careandguidancethataretailoredtoyourhealthhistory.
YOU NEED A REFERRAL TO HAVE UC SHIP PAY YOUR MEDICAL BENEFITS Carereceivedinanemergencydepartmentoratanurgent careclinicdoesnotrequireareferralfromtheSHC,but thecostwillnotbecoveredunlessAnthemBlueCross determinesserviceswererenderedinconnectionwithan emergencyorurgentmedicalcondition.Ifyouaccessother medicalservicesoutsidetheSHCwithoutareferral,your costswillnotbecovered. Also,keepinmindthatifyouarecoveredbyUCSHIP, youcanaccessdentalandvisionproviderswithout receivingareferral.
IF YOU GO TO A PROVIDER WITH A REFERRAL
ThereferralyoureceivefromtheSHCwillbeboundby visitlimitsand/ortimelimits.Theydefineyourperiod ofeligibilityforUCSHIPcoverageforthiscare.Youcan contactSHSforaneworextendedreferralifyouneed additionalcare. Whenyouchoosetheprovidertowhomyouwilltakeyour referral,workwiththeSHCorAnthemBlueCrosstolook foroptionsthatwillgiveyouthelowestpossibleout-of-pocketcost.Forexample,youwillhavetheoptiontouse non-networkphysicians,butyourcostswillbehigherand youwillhavetohandleyourownclaimspaperworksince youaren’tusinganetworkprovider.
WELCOME TO YOUR HEALTH HOME
CARE MUST BE CONSIDERED MEDICALLY NECESSARY InordertobeconsideredacoveredexpenseunderUC SHIP,allservicesmustbedeemedmedicallynecessaryby AnthemBlueCross.Thingstheytakeintoaccountwhen theyassessmedicalnecessityinclude,forexample,whether thecarefollowsgenerallyacceptedmedicalpractices, whetheritissafeandeffective,andwhetheritisrequired fordiagnosisandtreatment.
YOU CAN COVER DEPENDENTS
UCSHIPoffersIrvinegraduatestudentsavaluable coverageoption.IfyouarecoveredunderUCSHIP,you canenrolleligibledependentsformedical,dentaland visioncarecoveragewithin31daysofthebeginningofeach coverageperiod. Dependentshaveaseparatemedicalplan,plusthesame dentalandvisioncareplansthatgraduatestudentshave. Checkoutthespecificsectionsofthisbrochurefordetails.
VISION AND DENTAL COVERAGE TOO
ThemandatorygraduateplanatUCIrvineincludesdental andvisioncoverage.Descriptionsoftheseplanscanbe foundinsubsequentsectionsofthisbrochure.
KEEPTRACK
OFYOUR
ELIGIBILITY
INFO YOU’LL FIND IN THIS SECTION
Ifyouarearegisteredgraduatestudent. . . 14 Registeredgraduatestudentswhowaivecoverage. . . 14 Ifyouhavenon-registeredfilingfeestatus. . . 15 IfyouareregisteredinEMBA/FEMBA/HCEMBAor MPACprograms. . . 16 Ifyouareanon-registeredgraduatestudentonan approvedleaveofabsence. . . 16 Ifyouhaveeligibledependents. . . 17 Whenyougraduateorifyouarenolongerregistered. . . 17 Periodsofcoverage . . . 18FAQs
How and when am I charged for care at the SHC?
MostSHCservicesarepre-paidthroughyourcampus healthfees.Studentspaytheportionofchargesforwhich theyareresponsibleatthetimeofservice.
I’m graduating. When does my coverage end?
Yourcoverageendswithyourfinalacademicterm(ortothe endofthesummerifyougraduateinthespringterm).You maypurchaseUCSHIPforoneadditionaltermifyouwere coveredunderUCSHIPduringyourfinalacademicterm.
IF YOU ARE A REGISTERED GRADUATE STUDENT
AllregisteredgraduatestudentswithaGSHIPfeeassessed, includingregisteredinternationalstudentsandregistered in-absentiastudents,whoareautomaticallyenrolledin UCSHIParechargedahealthinsurancepremiumontheir registrationbill.Themandatoryprogramincludesmedical, dentalandvisioncoverage.
REGISTERED GRADUATE STUDENTS WHO WAIVE COVERAGE
Youmayprovideevidenceofhealthcoveragethrough anotherplanandrequesttowaiveenrollmentinUCSHIP.
Toqualifyforawaiver,thecoveragemustmeetbenefit criteriaestablishedbytheUniversityofCalifornia. Waiverapplicationsarecompletedonlineduringthefall, winterorspringwaiverperiod.VisittheSHCwebsiteat www.shc.uci.edutoviewwaiverdeadlinesandcomplete theonlinewaiverapplication. RegisteredgraduatestudentswithaGSHIPfeeassessed willbeautomaticallyenrolledinUCSHIPifawaiver applicationisnotsubmittedbythedeadline.
FAQS
Do I have to waive coverage every fall?
Yes.Thefalltermwaiverisgoodforoneacademicyear. Anewwaivermustbecompletedagainduringthefall waiverperiodpriortoeachacademicyearthatthestudent isregistered.
Are waivers available in the winter or spring terms?
Yes.AstudentwhowaivedUCSHIPenrollmentinthefall doesnotneedtocompleteanotherwaiverapplicationin thewinterorspring/summerterm.However,awinteror spring/summerwaiverisavailableforstudentsregistering forthefirsttimeinthewinterorspring,orwhodidnot waiveenrollmentinapriortermbutwanttowaiveforthe winterorspringterm.Awinterwaiverisvalidthroughthe endofsummer.Aspring/summerwaiverisvalidthrough theendofthesummer.
How do I pay for care at the SHC if I waive UC SHIP?
StudentsnotenrolledinUCSHIPcanreceivecareat theSHC,buttheSHCdoesnotdirectlybillinsurance plansotherthanUCSHIP.StudentswhowaiveUCSHIP enrollmentarepersonallyresponsibleforpayment.
IF YOU HAVE NON-REGISTERED FILING FEE STATUS
Allnon-registeredFilingFeestatusstudentswhoare completingworkundertheauspicesoftheUniversity ofCaliforniabutarenotattendingclassesarenot automaticallyenrolledinUCSHIP.
KEEP TRACK OF YOUR ELIGIBILITY
FilingFeestudentsareallowedtopurchaseUCSHIPfor amaximumofonesemester/quarter.Thestudentmust havebeenregisteredandcoveredbytheplanintheterm immediatelyprecedingthetermforwhichthestudent wantstopurchasecoverageor,ifthestudentwaived enrollmentinthepriorcoverageperiod,showproofofloss ofthecoveragethatwasusedtowaive.Proofoflossmeans anofficialletterofterminationfromtheinsurancecarrier. StudentsonFilingFeestatusmustpurchaseUCSHIP within31daysofthebeginningofthecoverageperiodby callingWellsFargoInsuranceServicesat(800)853-5899.
IF YOU ARE REGISTERED IN EMBA/FEMBA/HCEMBA OR MPAC PROGRAMS StudentswhoareregisteredinEMBA/FEMBA/HCEMBA orMPACprogramsarenotautomaticallyenrolled,but undertheconditionsoutlinedbelow,theymaypurchase UCSHIPvoluntarilythroughWellsFargoInsuranceServices at(800)853-5899. EMBA/FEMBA/HCEMBAandMPACstudentsareallowedto purchaseUCSHIPforamaximumofonequarter.Students whoarejoiningtheirprogramforthefirsttimemaycall WellsFargotoenrollinUCSHIP.Continuingstudentsmust havebeencoveredunderUCSHIPinthetermimmediately priortothetermforwhichtheywishtopurchasecoverage, orcontinuingstudentsmayshowproofoflossofcoverage fromthehealthinsurerforthecoverageineffectinthe termimmediatelypriortothetermforwhichtheywishto purchasecoverage.Proofoflossmeansanofficialletterof terminationfromtheinsurancecarrier.
IF YOU ARE A NON-REGISTERED GRADUATE STUDENT ON AN APPROVED LEAVE OF ABSENCE
Allnon-registeredgraduatestudentswhoareonan approvedleaveofabsencearenotautomaticallyenrolled inUCSHIP,buttheymayenrollonavoluntarybasis.These studentsmustpurchaseUCSHIPthroughWellsFargo InsuranceServicesat(800)853-5899. Whileinthisstatus,youmaypurchaseplancoveragefor amaximumofonesemesterortwoquarters.Youmust havebeencoveredbyUCSHIPinthetermimmediately precedingthetermforwhichyouwanttopurchase
coverageor,ifyouwaivedenrollmentinthepriorcoverage period,showproofoflossoftheplanusedtowaive.Proof oflossmeansanofficialletterofterminationfromthe insurancecarrier.
IF YOU HAVE ELIGIBLE DEPENDENTS
GraduatestudentswhoareenrolledinUCSHIPcansign uptheirdependentsforcoveragewithinthefirst31days ofeachcoverageperiodduringthebenefityear.Forfull details,refertothelatersectionondependentcoverage inthisbrochure.
WHEN YOU GRADUATE OR IF YOU ARE NO LONGER REGISTERED IfyouaregraduatingfromUCorifyouarelosingUCSHIP eligibilitybecauseyouarenolongeraregisteredstudent,it isimportanttoplanaheadforcontinuinghealthcoverage. StudentsgraduatingfromUCmaypurchaseUCSHIPmay purchaseUCSHIPforoneadditionalsemesterorquarter aftercoverageendsiftheywereenrolledintheplan duringtheirfinalacademicterm.YoumustcallWellsFargo InsuranceServicesbeforetheadditionalsemester/quarter beginsat(800)853-5899topurchasecoverageforthat timeperiod. OnceyourUCSHIPcoverageisterminated,youhave othercoveragechoices.Plantypesincludeshort-term coverage,individualplans,aconversionplanforindividuals withongoingmedicalconditionsandpublichealth insuranceprograms. ContacttheSHCforhelpdeterminingwhichofthese optionswillbestfityourneeds.FindUCSHIPonlineat www.ucop.edu/ucship.Cick“TellmemoreaboutUCSHIP.” Thenclick“InsuranceafterUCSHIP”intheleft-hand navigationbartoreviewyourinsuranceoptionswhenyour UCSHIPcoverageends.
KEEP TRACK OF YOUR ELIGIBILITY
PERIODS OF COVERAGE
Theperiodsofcoveragefollowthesemestersorquarters scheduledforyourschoolyear.Thisisalsotheschedulefor yourautomaticcoveragepayments.
term effective date termination date medical students (1st year)
Fall 8/5 /13 1 /1/14
Winter 1/2/14 3/25/14
Spring 3/26/14 9/28/14
medical students (2nd/3rd/4th years)
Fall 9/23/13 1/1/14 Winter 1/2/14 3/25/14 Spring 3/26/14 9/28/14 graduate students Fall 9/23/13 1/1/14 Winter 1/2/14 3/25/14 Spring 3/26/14 9/28/14
law students (1st year)
Fall 8/14/13 1/1/14
Spring 1/2/14 9/28/14
law students (2nd/3rd/4th years)
Fall 9/23/13 1/1/14
HEALTHY
USER
INFO YOU’LL FIND IN THIS SECTION
Beginningthisyear,mostcoveragecapsremoved. . . 21 WhenyougototheSHC. . . 21 Makethemostoffreepreventivecare . . . 21 Ifyouneednon-emergencymedicalcareforinjuryorillness. . . . 22 Ifyouneedcounselingorpsychiatricservices. . . 22 Youcantalkwithanurse24/7. . . 22 Ifyouneedtobehospitalized. . . 23 Ifyouhaveanemergency. . . 23 Ifyouareanexpectantparent. . . 23 Ifyoubecomeanewmotherorfather. . . .24 Ifyouneedaprescriptionfilled. . . .24 Howtomakethemostofyourbenefits . . . 25 Benefityeardeductible. . . 26 Annuallimitonyourout-of-pocketcosts. . . 26 Whatiscovered. . . 26 Whatisnotcovered. . . 34FAQs
Do I have to make an appointment to visit the SHC?
No.Youcandropinwheneveryouneedcareor wanttotalkthingsover;however,anappointmentis stronglyrecommended.Therearetwowaystomakean appointment.Youcancall(949)824-5304oryoucanstop bytheSHCFrontOffice.
What happens if I get care outside of the SHC without getting a referral first?
AllyourhealthcarestartsattheSHC.Whencovered studentsdonotobtainawrittenreferralfromtheSHC beforereceivingnon-emergencymedicalorbehavioral healthcareoutsidetheSHC,theservicestheyreceiveare notcovered. YoudonotneedareferralfromtheSHCtoreceivecarein anemergencydepartmentoratanurgentcareclinic.
BEGINNING THIS YEAR, MOST COVERAGE CAPS REMOVED BeginningwiththeUCSHIPstudentanddependent coverageforthe2013–2014schoolyear,thereare: • Nolifetimelimitsonyourmedicalandbehavioral healthbenefits • Nolimitsonpharmacyprescriptionbenefits • Nocapsonessentialhealthbenefitsasdefinedunder theAffordableCareAct(ACA) Wearevoluntarilyprovidingyouwiththisvaluablebenefit toalignwiththeAffordableCareAct(ACA)—eventhough wearenotsubjecttothelegislation—becausewebelieveit isinthebestinterestsofourstudents.
WHEN YOU GO TO THE SHC
Mostofyourhealthcareneedscanbehandledbythe staffattheSHC.Considerityourhealthhome,where youcanobtainthecareofyourprimarycarephysicianor nursepractitioner,nurses,psychiatrists,otherprofessional healthcareprovidersandinsurancespecialists.Youcan visittheSHCwithorwithoutanappointment,although anappointmentishighlyrecommended.Tomakean appointment,calltheSHCat(949)824-5304orstopinto theSHCFrontOffice.
If you are enrolled under UC SHIP as a student and you need non-emergency medical care, you must first go to the SHC for treatment or to obtain a written referral. MAKE THE MOST OF FREE PREVENTIVE CARE
Gettingfreepreventivecarecouldn’tbeeasier—it’sright oncampusattheSHC.Lookatthislistofcoveredservices. Itisaselectionofthefreepreventivecareavailabletoyou attheSHCthroughUCSHIP. • Annualroutinephysicalexam • Cervicalcancerscreening • Mammograms • Prostatecancerscreening • Preventiveimmunizations • Tuberculosisscreening
HEALTHY USER GUIDE
IF YOU NEED NON-EMERGENCY MEDICAL CARE FOR INJURY OR ILLNESS YourprimarycareclinicianattheSHCistheplacetostart. Ifyouneedcarethatcan’tbehandledattheSHC,your primarycareclinicianwillprovideyouwithareferraland theSHCwillhelpyoulinkwiththeAnthemBlueCross networkofspecialists,hospitalsandotherproviders.
IF YOU NEED COUNSELING OR PSYCHIATRIC SERVICES
Accessisconvenientandyourcarewillbepersonalized. YoucancontacttheCounselingCenteroncampusor dropbyduringofficehourstomakeanappointment.The CounselingCenteristherewhenyouneedit,soyoucanuse thedrop-inserviceormakesame-dayappointmentsaswell. Needurgentassistanceorjustwanttomakean appointment?Thetelephonenumberis(949)824-6457or visittheCounselingCenterwebsiteatwww.chs.uci.edu. Psychiatristsareavailabletoconductevaluationsand prescribemedicallynecessarytherapeuticdrugs.When longer-termtherapyisneeded,theCounselingCenterand theSHCclinicianprovideareferralsoyoucanaccessoff-campusnetworkpractitionerscoveredunderUCSHIP. IfyoureceiveareferralfromtheCounselingCenterandthe SHCclinician,youcanalsosearchwww.anthem.com/ca foratherapistorpsychiatristwhospecializesinyourarea ofconcern,suchaseatingdisorders,depression,grief counselingorotherareasofspecialization. UCSHIP’smentalhealthbenefitscomplywiththe CaliforniaMentalHealthParityLaw,whichrequires thatmentalhealthconditionsbecoveredasany othermedicalillnesswouldbeforbothinpatientand outpatienttreatment.
YOU CAN TALK WITH A NURSE 24/7
Youhaveanumberofwaystospeakwitharegisterednurse whoistrainedtohelpyoumakeinformeddecisionsabout yourhealthsituation.DropintotheNurseClinicattheSHC duringnormalbusinesshoursormakeanappointmentat (949)824-5304. Coveredstudentsanddependentshaveaccesstoanurse 24hoursaday,365daysayearthroughtheAnthemBlue Cross24/7NurseLinebycalling(877)351-3457.
IF YOU NEED TO BE HOSPITALIZED StudentscoveredbyUCSHIParerequiredtoworkwith theSHCtoplanahospitalization.Ifcovereddependent childrenneedhospitalization,youcanworkdirectlywith AnthemBlueCross. YourSHCprimarycarecliniciancanhelpyoufinda hospitalthatqualifiesasanetworkfacilityunderAnthem BlueCrossandthathasagreedtoacceptAnthemBlue Cross’negotiatedrates,whichwillhelpmakeyourstay moreaffordable. Ifyouchoosetoreceivecareatanon-networkhospital,you willpayaninpatientdeductibleandnon-networkratesthat willbehigher,generally,thanatanetworkfacility. InadditiontocontactingtheSHC,youcancalltheAnthem BlueCrosscustomerservicetelephonenumberonyourID cardforhelpinfindinganetworkhospital.
IF YOU HAVE AN EMERGENCY
Incaseofemergency,youshouldreportdirectlytothe emergencydepartmentofthenearesthospital.SHCreferralsare notrequiredforcareprovidedinanemergencydepartmentorat anurgentcareclinic. AnthemBlueCrossdefinesanemergencyasasudden, seriousandunexpectedacuteillness,injuryorcondition (includingsuddenandunexpectedseverepain)thatyou reasonablyperceivecouldpermanentlyendangeryour healthifmedicaltreatmentisnotreceivedimmediately. AnthemBlueCrossmakesthesoleandfinaldetermination astowhetherserviceswererenderedinconnectionwith anemergency.
IF YOU ARE AN EXPECTANT PARENT
InadditiontotheAnthemBlueCross24/7NurseLine, studentsortheircovereddependentswhoarepregnant haveaccesstoaregisterednurse24hoursaday,seven daysaweektoanswerexpectantornewparents’questions aboutimportanttopicsrelatedtopregnancysuchaslabor, nursing,postpartumdepression,etc. AnthemBlueCrossoffersaFutureMomsprogramtohelpwith wellnessandpreparationofpregnantUCSHIPmembers.Ifyou
HEALTHY USER GUIDE
enroll,AnthemBlueCrosswillsendyoua$30Babies“R”Us®gift card.RegisterfortheFutureMomsprogramatnoadditional costbycallingtollfree(866)664-5404. Inpatienthospitalcareinconnectionwithchildbirthwillbe coveredforatleast48hoursfollowinganormaldelivery (96hoursfollowingacesareansection).
IF YOU BECOME A NEW MOTHER OR FATHER
NotifyAnthemBlueCrosswithin31daysafterthebirthso yourbabywillbeeligibleforthefollowingbenefits. • Coverageuptothefirst31daysafterbirthorupto amaximumlifetimebenefitof$25,000(whichever occursfirst)isprovidedforthebabyunderthe student’splan.Coverageis90%ofthemaximum allowedamountforAnthemBlueCrossnetwork providersor60%ofthemaximumallowedamountfor non-networkproviders. • Forcoveragebeyondthefirst31daysafterbirthor beyond$25,000inbenefits,enrollthenewborninUC SHIPasadependentwithin31daysofbirth.Coverage is80%ofthemaximumallowedamountforAnthem BlueCrossNetworkproviders’services.Studentscan enrollnewbornsbycontactingWellsFargoInsurance Servicesat(800)853-5899.
IF YOU NEED A PRESCRIPTION FILLED
Startingwiththe2013–2014planyear,Ventegra PharmacyServicesisthepharmacybenefitadministrator forUCSHIP.Youcancontactthemat(877)867-0943. Thisinformationisalsoconvenientlyaccessibleon yourAnthemBlueCrossIDcardoryoucanloginat https://members.rxclearinghouse.com/Login.aspxtofind outmoreaboutyourpharmacybenefits. Togetaprescriptionfilled,takeyourprescriptiontothe SHCpharmacyortoanetworkpharmacyandpresent yourAnthemBlueCrossIDcard.Theamountyoupayfor acoveredprescription—yourcopay—willbedetermined bywhetherthedrugisageneric,brand-nameformularyor brand-namenon-formularymedication. Ifyouchoosetofillyourprescriptionatanon-network pharmacy,yourcostswillincrease.Youwilllikelyneedto payfortheentireamountoftheprescriptionandthen submitaprescriptiondrugclaimformforreimbursement.
Thepharmacistmustcompleteandsigntheappropriate sectionoftheclaimformtoensureproperprocessingof theclaimforreimbursement. Ifyousubmitclaimsfromnon-networkpharmacies,your reimbursementwillbebasedonalimited-feeschedule.The feeschedulemaybeconsiderablylessthanthecostofthe medication.Youareresponsibleforpayinganydifference. Coveredprescriptionsarelistedinaformularythatincludes brandandgenericmedicationsthathaveundergone extensivereviewfortherapeuticvalueforaparticular medicalcondition,safetyandcost.Youcanseethelist onlineatwww.ucop.edu/ucshipundertheDescriptionof Benefitssectiononyourcampushomepage.
HOW TO MAKE THE MOST OF YOUR BENEFITS
Withmedicalcoveragethatexceedsthehighstandardsset bytheAffordableCareAct(ACA),UCSHIPmakesahealthy UCexperienceaffordable.Readoveryourcoverage,make thoughtfulchoicesandyou’llmakethemostofthesavings availabletoyou.
All your health care starts at the SHC. If you are enrolled under UC SHIP as a student and you need non-emergency medical care, you must first go to the SHC for treatment or to obtain a written referral.Ifstudentsdo
notobtainawrittenreferralfromtheSHCbeforereceiving off-campusnon-emergencymedicalorbehavioralhealth care,theserviceswillnotbecoveredunderUCSHIP.Care inanemergencydepartmentoratanurgentcarecenter doesnotrequireareferralfromtheSHC. Forthemaximumbenefitpayment,youmustreceive carewithintheAnthemBlueCrossPPOPrudentBuyer network.Ifyouuseprovidersorfacilitiesthatarenotpart oftheAnthemBlueCrossPPOPrudentBuyernetwork, yourclaimswillbepaidbasedonthelowernon-network maximumallowedamount.
HEALTHY USER GUIDE
BENEFIT YEAR DEDUCTIBLE Thedeductibleistheamountofmoneyyoupayoutof yourownpocketbeforeAnthemBlueCrossbeginspaying forservices. • YoupaynodeductiblewhenyougototheSHCforcare. • Youpaya$300deductibletowardcareoutsideoftheSHC. Thebenefityeardeductibleappliestoallserviceslisted inthefollowing“Whatiscovered”section,exceptwhere noted.Thedeductibledoesnotapplytopharmacyservices.
ANNUAL LIMIT ON YOUR OUT-OF-POCKET COSTS
Onceyoupay$3,000incoinsurancefornetworkservices, orseparately$6,000fornon-networkservices,youarenot requiredtopaycoinsurancetowardtheseservicesforthe remainderofthebenefityear. Themaximumout-of-pocketlimitdoesnotapplytoset-dollarcopayments,amountsexceedingstatedbenefitlimits (seeexplanationofmaximumallowedamountsinthenext sectionon“Whatiscovered”)ortoservicesnotcovered bytheplan.Thenetworkandnon-networkcoinsurance maximumsareseparate;neitheraccumulatestowardthe other. WHAT IS COVERED Thisisabriefsummaryofyourmedicalbenefits.Finda fulllistofcoveredservicesatwww.ucop.edu/ucship.Click on“TellmemoreaboutUCSHIP”andselectyourcampus homepagefromtheleft-handnavigationbartofindthe “BenefitBooklet.” KeepinmindthatAnthemBlueCrosssetsallowed maximumsforservicesprovidedbynetworkandnon-networkproviders.Thefollowingbenefitsummaryliststhe percentageoftheallowedmaximumthattheplanpays.For example,ifthesummarylistscoverageat90%andthereis a$100.00allowedmaximumamountforatreatment,then theplanpays$90.00towardthebill.
THE ANNUAL DEDUCTIBLE APPLIES TO ALL SERVICES LISTED BELOW, EXCEPT AT THE SHC AND WHERE NOTED
OUTPATIENT SERVICES
Medical office visits AtSHC 100%after $15copaymentfor primarycare, $30copaymentfor specialtycare OutsideofSHC Networkproviders 100%after $15copaymentfor primarycare, $30copayment forspecialtycare, deductiblewaived Non-network providers 60% Behavioral health office visits AtSHC 100%after $15copayment OutsideofSHC Networkproviders 100%after $15copayment, deductiblewaived Non-network providers 60% Routine physicals/ student adult preventive care AtSHC 100% OutsideofSHC Networkproviders 100%, deductiblewaived Non-network providers 60%Urgent care OutsideofSHC
Networkproviders 100%after$50 copayment, deductiblewaived Non-network providers 60%
HEALTHY USER GUIDE
OUTPATIENT SERVICES
Prescription drugs (Notsubjectto deductible) AtSHC • $10generic • $35brand-name formulary, 30-daysupply • $50brand-name non-formulary, 30-daysupply Ventegranetwork pharmacy • $10generic • $35brand-name formulary, 30-daysupply • $50brand-name non-formulary, 30-daysupply 100%forFDA-approvedgeneric prescriptioncontraceptivesandbrand-nameprescriptioncontraceptiveswhena genericequivalentisnotavailable Contraceptives Networkproviders 100%,deductible waived Non-network providers 60% CoverageforFDA-approvedservicesand suppliesprovidedinconnectionwiththe followingmethodsofcontraception: • Injectabledrugsandimplantsforbirth control,administeredinaphysician’s office,ifmedicallynecessary • Intrauterinecontraceptivedevices (IUDs)anddiaphragms,dispensedbya physician,ifmedicallynecessary • Professionalservicesofaphysician inconnectionwiththeprescribing, fittingandinsertionofintrauterine contraceptivedevicesordiaphragms Ifyourphysiciandeterminesthatnoneof theseprescriptioncontraceptivemethods isappropriateforyoubasedonyour medicalorpersonalhistory,coveragewill beprovidedforanalternativemethodthat isapprovedbytheFDAandprescribedby yourphysician.OUTPATIENT SERVICES
Mammograms, preventive AtSHC 100% OutsideofSHC Networkproviders 100%, deductiblewaived Non-network providers 60% Lab tests, X-rays and imaging AtSHC 90% OutsideofSHC Networkproviders 90% Non-network providers 60% Surgery Physiciansand anesthesiologists Networkproviders 90% Non-network providers 60% Outpatientsurgery center 90%Maximum allowed amount reduced by 25%forservicesandsuppliesprovidedby anon-contractinghospital,exceptincases ofemergencyadmission Acupuncture (20-visit maximumper benefityear) OutsideofSHC Networkproviders 100%after$20 copayment, deductiblewaived Non-network providers 60%
HEALTHY USER GUIDE
OUTPATIENT SERVICES
Allergy testing and injections OutsideofSHC Networkproviders 90% Non-network providers 60% Ambulance — ground 90%ifpatientreceivesemergencycareor ishospitalized Ambulance — air 100%ifpatientreceivesemergencycareor ishospitalized Chiropractic services and osteopathic manipulation OutsideofSHC Networkproviders 100%after$30 copayment, deductiblewaived Non-networkproviders 60%Dental care UCSHIPmembersreceivedentalcoverage throughDeltaDental.Seethe“YourDental Coverage”sectionofthisbrochure. Dental injury to natural teeth OutsideofSHC Networkproviders 90% Non-networkproviders 60% Durable medical equipment (DME) 90%ofrentalorpurchaseofmedical equipmentandsupplies,includingrental orpurchaseofdiabeticequipmentand supplies(butexcludinginsulin),thatare orderedbyaphysician,obtainedfrom anetworkdurablemedicalequipment supplierandareofnofurtherusewhen medicalneedends Home health visits OutsideofSHC Networkproviders 100% Non-networkproviders 60%
OUTPATIENT SERVICES
Hospice care andbereavement counseling OutsideofSHC Networkproviders 90% Non-networkproviders 60% Immunizations Diphtheria/tetanus/pertussis;measles, mumpsandrubella;meningococcal; varicella;influenza;hepatitisAand hepatitisB;pneumococcal;polio;and humanpapillomavirus(firstinjectioninthe seriesmustbeadministeredbeforeage27) AtSHC 100% OutsideofSHC Networkproviders 100%, deductiblewaived Non-networkproviders 60% Other
immunizations AtSHC90% OutsideofSHCNetworkproviders
90% Non-networkproviders 60% Tuberculosis screening and testing Forpreventiveexams,campus-required activitiesandnon-campusrequirements foremploymentandotherprograms AtSHC 100%
For medical reasons
AtSHC 90% OutsideofSHC Networkproviders 90% Non-network providers 60%
HEALTHY USER GUIDE
OUTPATIENT SERVICES
Prenatal care,maternity and abortion
Prenatal care OutsideofSHC
After$15 copaymentforfirst officevisit,100% forin-network officevisits, deductiblewaived Maternity OutsideofSHC Networkproviders 90% Non-network providers 60% Abortion OutsideofSHC Networkproviders 90% Non-network providers 60% Physical therapy, physical medicine, occupational therapy and speech therapy OutsideofSHC Networkproviders 100%after$30 copayment, deductiblewaived Non-network providers 60% Podiatric services OutsideofSHC Networkproviders 90% Non-network providers 60% Psycho-educational testing 90%ofbilledchargesupto$2,000 lifetimemaximumforpsycho-educational testingconductedbyalicensedclinical, educational,orcounselingpsychologist orneuropsychologisttoassessand diagnosefunctionallimitationsdueto learningdisabilities
OUTPATIENT SERVICES
Hearing aids 90%ofmaximumallowableamountfor onehearingaidperear,everyfouryears Non-networkprovidernotcovered
Skilled nursing OutsideofSHC
Networkproviders 90% Non-network providers 60% Medical evacuation Necessaryexpensesupto$10,000, deductiblewaived,forreturntoyourhome countrywhenpriorauthorizationhas determinedmedicalnecessity Repatriation IfyoudiewhileenrolledinUCSHIP, theplanpaysnecessaryexpensesupto $7,500,deductiblewaived,incurredto meettheminimumlegalrequirements fortransportationofhumanremains.This benefitincludespreparationandtransport ofyourremainsfromtheUnitedStates tothecountryofyourpermanentlegal residenceor,ifyouareapermanentlegal residentoftheUnitedStates,fromthe countryinwhichyouaretravelingtothe UnitedStates.
EMERGENCY ROOM SERVICES
Emergency room 100%after$100copayment,deductiblewaived
Copayment waived if admitted
Note:Emergencyroomservicesreceivedatanon-network hospitalorfromnon-networkcliniciansatanin-network hospitalwillresultinadditionalchargestothestudentafter AnthemBlueCrosspaystheclaimat100%ofthemaximum allowedamount. Attending physicians 100%,deductiblewaived
HEALTHY USER GUIDE
INPATIENT HOSPITAL SERVICES
• Includesmedicalservices,behavioralhealthand maternityservices • Non-networkhospitalorresidentialtreatmentcenter requiresa$500deductibleperadmission,waivedincases ofemergencyadmission• Coverage reduced by 25% for services and supplies
provided by a non-contracting hospital, except in cases of emergency admission network non-network Semi-private room 90% 60% Inpatient surgery 90% 60% Physicians and specialists 90% 60% Nursing services 90% 60%
Lab tests, X-rays and imaging 90% 60% Medication 90% 60% General supplies 90% 60% Sex reassignment surgery 90% Notcovered
WHAT IS NOT COVERED
Someoftheexpensesandservicesthatareexcludedfrom coveragebyUCSHIParelistedbelow.Foracompletelist oftheitemsandservicesthattheplanexcludes,goto www.ucop.edu/ucship.Clickon“TellmemoreaboutUC SHIP,”selectyourcampushomepagefromtheleft-hand navigationbarandclickon“DescriptionofBenefits”tofind the“BenefitBooklet.”YoucanalsocontactAnthemBlue CrossCustomerServiceat(866)940-8306.
Don’t forget!Ifyouobtainnon-emergencymedicalservices outsideoftheSHCduringtheschoolyearwithoutfirstobtaining awrittenreferralfromtheSHC,yourcostswillnotbepaidby UCSHIP. Hereisapartiallistofexclusions: • Amountsinexcessofcoveredexpensesorany benefitmaximum • Clinicaltrialsexceptcancerclinicaltrialsthatare specificallylistedascovered • Commercialweightlossprogramsandhealthclub memberships • Contraceptivedevicesthatarenotspecificallylisted ascovered • Cosmeticsurgery • Custodialcareorrestcures • Diabeticsuppliesthatarenotspecificallylisted ascovered • Educationorcounselingthatisnotspecifically providedorarrangedbyAnthemBlueCross • Experimentalorinvestigativeproceduresor medications,althoughyoumayrequestan independentmedicalreview • Eyesurgeryforrefractivedefectssuchas nearsightednessorastigmatism;contactlensesor eyeglassesrequiredasaresultofsuchsurgery • Foodordietarysupplements • Government-providedtreatments • Infertilitytreatments • Inpatientdiagnosticteststhatcouldhavebeen performedsafelyonanoutpatientbasis • Lifestyleprograms • Non-licensedhealthcareproviders • Notmedicallynecessary • Orthopedicsuppliesthatarenotspecificallylisted ascovered • Outpatientprescriptiondrugsormedicationsthat arenotspecificallylistedascovered
HEALTHY USER GUIDE
• Personalitemsforcomfort,hygieneorbeautification • Private-dutynursing • ServicesnotspecificallylistedintheBenefitBooklet ascoveredservices • Servicesofrelatives • Servicesreceivedbeforeyoureffectivedateorafter yourcoverageperiodends,exceptascoveredunder continuationofbenefits • Sports-relatedconditionsresultingfromintercollegiate orprofessionalsports • Sterilizationreversal • Surrogatemotherservices • Work-relatedconditionsifbenefitscanberecovered underworkers’compensationcoverageorlaw
WISE
USER
GUIDE
INFO YOU’LL FIND IN THIS SECTION
YourAnthemBlueCrossIDcard . . . 38 YourAnthemBlueCrosscontract. . . 39 YouneedareferralforcareoutsideoftheSHC . . . 39 Yourdependentsdon’tneedareferral. . . .40 Emergencycare. . . .40 Filingamedicalorcounselingandpsychological servicesclaim. . . .40 Paymentofabillcanbedenied. . . 41 IfyouarecoveredbyUCSHIPandasecondinsuranceplan. . . 41 Yourprivacy. . . .42 Coverageduringtermbreaks. . . .42 IfyoutraveloutsidetheUnitedStates . . . 43 Ifyoutakealeave. . . .44FAQs
If I have an emergency what should I do?
Reportdirectlytotheemergencydepartmentofthenearest hospital.Referralsarenotrequiredifyoureceivecare inanemergencydepartmentoratanurgentcareclinic, buttreatmentwillbecoveredonlyifAnthemBlueCross determinesitwasanurgentoremergencysituation.
I need care during a term break. What do I do?
YoumustcontacttheSHCtoreceiveareferralbeforeyou obtaincarethatisnotprovidedeitherinanemergency departmentoratanurgentcareclinic.
YOUR ANTHEM BLUE CROSS ID CARD
Youneedtoshowyouhavecoverageeachtimeyouget care.BringyourstudentIDcardandyourUCSHIPAnthem BlueCrossIDcardwhenyougototheSHCoraprovider offcampus.IfyouloseyourAnthemBlueCrossIDcard, contactCustomerServiceat(866)940-8306forassistance increatingatemporaryIDcard.
YOUR ANTHEM BLUE CROSS CONTRACT Someoftheexpensesandservicesthatareexcludedfrom coveragebyUCSHIParelistedbelow.Foracompletelist oftheitemsandservicesthattheplanexcludes,goto www.ucop.edu/ucship.Clickon“TellmemoreaboutUC SHIP,”selectyourcampushomepagefromtheleft-hand navigationbarandclickon“DescriptionofBenefits”tofind the“BenefitBooklet.”YoucanalsocontactAnthemBlue CrossCustomerServiceat(866)940-8306.
YOU NEED A REFERRAL FOR CARE OUTSIDE OF THE SHC
IfyouwantcoverageforcareoutsideoftheSHC,it’s importanttocompleteallofthesesteps. 1. You’vegottostartattheSHCtoreceiveawritten referralfromyourprimarycareclinicianbeforeyou receivecareoutsideoftheSHC. Youmustcompletethisstepformostnon-emergency medicalandbehavioralhealthcareservicestoqualify forUCSHIPcoverage.Otherwise,theclaimswillnotbe coveredunderUCSHIP. 2. Whenyoureceiveareferral,youwillneedtochoosea healthcareproviderforyourcare.UCSHIPcontracts withAnthemBlueCrosstoprovidemedicaland behavioralhealthservicesthroughitsextensivePrudent Buyernetworkofhospitalsandproviders. Ifyouchooseanon-networkprovider,claimswillbe paidatalowerpercentage;notethattheprovider’s chargesmaybesignificantlyhigherthanAnthemBlue Cross’maximumallowedamount.Inthiscase,you willberesponsibleforpayingthedifferencebetween theprovider’sbilledchargeandthemaximumallowed amount.SHCstaffcanhelpstudentslocateAnthem BlueCrossPPOproviders. 3. Referralsaremadeatthesoleandabsolutediscretion oftheSHC.Thereferraldoesnotguaranteepayment orcoverage.Checktomakesurethecareyouplanto receiveisacoveredbenefitunderUCSHIPanddeemed medicallynecessarybyAnthemBlueCrossbycalling AnthemBlueCrossCustomerServiceat(866)940-8306 orfindingthedetailsofyourcoverageintheBenefit Booklet.Finditonlineatwww.ucop.edu/ucship.Clickon “TellmemoreaboutUCSHIP”andselectyourcampus
WISE USER GUIDE
homepagefromtheleft-handnavigationbarandclick on“DescriptionofBenefits”tofindthe“BenefitBooklet.”
YOUR DEPENDENTS DON’T NEED A REFERRAL
DependentscoveredunderUCSHIParenotrequiredto obtainanSHCreferraltoobtaincarefromAnthemBlue Crossnetworkproviders.However,toavoiddenialof benefits,makesureyourdependentsuseonlyproviders whoparticipateintheAnthemBlueCrossPPOPrudent Buyernetwork. EMERGENCY CARE Incaseofemergency,studentsshouldreportdirectlytothe emergencydepartmentofthenearesthospital. SHCreferralsarenotrequiredifyoureceivecareinan emergencydepartmentoratanurgentcareclinic,butthe costwillbecoveredonlyifAnthemBlueCrossdetermines itwasanemergencysituation.AnthemBlueCrossdefines anemergencyasasudden,seriousandunexpected acuteillness,injuryorcondition(includingsuddenand unexpectedseverepain)thatyoureasonablyperceivecould permanentlyendangeryourhealthifmedicaltreatmentis notreceivedimmediately.AnthemBlueCrossmakesthe finaldeterminationofwhatqualifiesasanemergency.
FILING A MEDICAL OR COUNSELING AND PSYCHOLOGICAL SERVICES CLAIM
ForservicesprovidedattheSHC,studentspaythe portionofchargesforwhichtheyareresponsibleatthe timeofservice.TheSHCfilesaclaimwithUCSHIPforthe remainderofthecharges,ifany. ForservicesreceivedoutsideoftheSHCwithawritten referral,eitheryouoryourprovidersubmitstheitemized billstoAnthemBlueCross.Claimsmustbereceivedno laterthan11monthsafterthedatethehealthcareservice isrendered. Here’showittypicallyworks.Mosthealthcareproviders requirepaymentofthestudent’sportionoffeesatthetime ofservice.Networkproviderswillsubmitaclaimforthe remainingportionofthebilldirectlytoAnthemBlueCross foryou.Non-networkprovidersusuallyrequiremembersto submittheirownclaimtoAnthemBlueCross.Ifyoureceive
abillforthefullcostofservices,contactAnthemBlue CrossforassistanceorseekguidanceattheSHC. ExpecttoreceiveanExplanationofBenefits(EOB)from AnthemBlueCrosswithinsixweeksaftersubmittingabill showingwhatwaspaidonyourclaim.Forquestionsabout claimsortheEOB,callAnthemBlueCrossat(866)940-8306.
PAYMENT OF A BILL CAN BE DENIED
PleasenotethatAnthemBlueCrosscandenypayment ofabillifyoudonotfollowtheplanguidelines.Thereare numerousexamplesofhowthatcancomeabout,butthe mostfrequentlyoccurringreasonisifyouskipcareatthe SHCandgodirectlytootherproviderswithoutreceiving areferralfromtheSHC.Ifyouhavenotreceivedareferral fromtheSHC,AnthemBlueCrosscandenypaymentof yourbill. Therearedetailsthroughoutthisbrochurethatalertyouto choicesthatwillcauseyoutoloseeligibilityforcoverage. ContacttheSHCorAnthemBlueCrossCustomerServiceat (866)940-8306ifyouhaveanyquestionsaboutqualifying forcoverage.
IF YOU ARE COVERED BY UC SHIP AND A SECOND INSURANCE PLAN Togetthemostoutofyourcoverage,youneedtobecome familiarwithhowthetwoplansworktogether,whichis calledcoordinationofbenefits. PleasecallAnthemBlueCrossCustomerService at(866)940-8306.Finddirectionsonlineat www.ucop.edu/ucship.Clickon“TellmemoreaboutUC SHIP,”selectyourcampushomepagefromtheleft-hand navigationbarandgoto,“Doyouhaveotherinsurance?”to completetheCoordinationofBenefits(COB)questionnaire withinformationaboutyourotherhealthplan. UCSHIPcoversservicesattheSHCregardlessofwhether studentshavecoveragethroughanotherhealthplan. TheSHCwillsubmitclaimstoAnthemBlueCrossfor SHCservices.Afterthestudentpaysthecopaymentor coinsuranceamountthatUCSHIPconsidersthestudent’s responsibility,thestudentmustsubmittheclaimstotheir otherinsurancecarrierforreimbursementofthatamount. TheSHCdoesnotsubmitclaimstootherhealthplans.
WISE USER GUIDE
ForservicesreceivedoutsideoftheSHC,thestudent’s othermedicalplanwillbeconsideredtheprimaryplan, meaningthatplanmustpayclaimsfirst.Aftertheprimary planprocessesandpaysaclaim,anyremainingcharges maybesubmittedtoUCSHIP(thesecondaryplan).This holdstrueforallmedicalplansexceptMedi-Cal,MRMIP andTriCare.Ifastudentiscoveredbyanyoftheseplans, UCSHIPwillbetheprimaryplan,andMedi-Cal/MRMIP/ TriCarewillbethesecondaryplan. Forquestionsaboutcoordinationbetweenplans,call AnthemBlueCrossCustomerServiceat(866)940-8306. YOUR PRIVACY TheSHCiscommittedtoprotectingyourprivacyandthe confidentialityofyourhealthinformation.Specifically, yourhealthinformationwillbeusedordisclosedonlyfor purposesrelatedtoyourtreatment,paymentofyourfees andinsuranceclaims,andforSHCandUCSHIPoperations. Unlessallowedbylaw,yourhealthinformationcannotbe disclosedtoanyoneforanyotherpurposewithoutyour writtenauthorization. Commentsorconcernsaboutprivacyissuesmaybesent totheSHC.TheSHCandUCSHIPprivacypoliciesare availableonline.ClicktotheUCSHIPhomepagefrom www.ucop.edu/ucship. Hereisanexampleofourprivacypractices.Ifstudentsdo notpaytheirportionofSHCfees,oriftheSHCserviceis deniedcoveragebyUCSHIP,thestudent’scampusaccount maybebilledfortheoutstandingamount.Thebilling statementwillstateonlythatthechargeswereincurredat theSHC.Nohealthinformationisreleasedtothecampus billingoffice.ForservicesoutsidetheSHC,chargeswillbe sentdirectlytotheinsured’s(student’s)address.
COVERAGE DURING TERM BREAKS
StudentswhoareactivelyenrolledinUCSHIParecovered evenwhentheyareoffcampusonbreak.Remember,the costofyourcarewillbelessifyouuseanAnthemBlue Crossnetworkprovider.Inthenextsection,youwillfinda descriptionofthetravelmedicalcoverageUCSHIPprovides. Thereisnogapincoverageduringtermbreaks,butyou mustcontacttheSHCforareferralfornon-emergencyor non-urgentcare.
SHCreferralsarenotrequiredifyoureceivecareinan emergencydepartmentoratanurgentcareclinic,butthe costwillbecoveredonlyifAnthemBlueCrossdetermines itwasanemergencysituation.
IF YOU TRAVEL OUTSIDE THE UNITED STATES
Whethertravelingorlivingoutsideofthecountry,you andyourdependentscoveredunderUCSHIPcanusethe BlueCardWorldwideprogramwhencareisneeded.You mayalsobeeligiblefortravelaccidentcoverageifyouare travelingonUCbusiness.
Here’s what to do before you leave:
• BeforeleavingtheUnitedStates,calltheCustomer ServicenumberonthebackofyourAnthemBlueCross IDcardtofindoutexactlyhowyouarecoveredabroad. • CalltheSHCtoobtaininformationoncoveragefor internationalvaccinesandtheadditionalUCTravel AccidentPolicy,whichisdescribedbelow. • Ifyouareastudentwhoistravelingonuniversity business,checktoseeifyouareeligiblefor travelaccidentinsuranceadministeredbythe UCOfficeofthePresidentatnoadditional costtostudents.Youmustregisterbeforeyouleaveon yourtriptoreceivethecoverage.Registrationissimple andtakeslessthanfiveminutes.Formoreinformation andtoregister,gotowww.ucop.edu/risk-services/. • MakearecordofimportantSHCphonenumbersand packyourUCandAnthemBlueCrossIDcards.The AnthemBlueCrossphonenumbersareonyourIDcard.
Here’s what to do when you are traveling:
• Alwayscarryyourup-to-dateUCandAnthemBlue CrossIDcards. • Inanemergency,gotothenearesthospital. • Ifyouneednon-emergencycare,contacttheSHCfor areferraltoensurethatyourclaimforcoveredservices willbepaidaccordingtoplanbenefits. • Ifyouneedhelpfindingadoctororhospital,orifyou haveanyquestionsaboutgettingcareabroad,call theBlueCardWorldwideServiceCentertollfreeat (800)810-BLUE(2583)orcollectat(804)673-1177, 24hoursaday,sevendaysaweek.Someonewillhelp
WISE USER GUIDE
youand,alongwithamedicalprofessional,arrangefor youtoseeadoctororhaveahospitalstay,ifneeded. • Ifyouneedtobeadmittedtothehospital,callthe
BlueCardWorldwideServiceCentertollfreeat (800)810-BLUE(2583)orcollectat(804)673-1177.
Here’s what happens if you need to file a claim:
• IftheBlueCardWorldwideServiceCenterarranged yourhospitalization,thehospitalwillfiletheclaimfor you.Youwillneedtopaythehospitalfortheout-of-pocketyouwouldnormallypay(e.g.,deductible, copayment,coinsurance). • Foroutpatientanddoctorcareorinpatientcarenot arrangedthroughtheBlueCardWorldwideService Center,youwillneedtopaythehealthcareprovider andsubmitaninternationalclaimformwiththe originalbillstotheServiceCenter. • Internationalclaimformsareavailableby callingtheCustomerServicenumberonyour IDcardortheServiceCenterbygoingto www.bcbs.com/bluecardworldwide.Orcallthe BlueCardWorldwideServiceCentertollfreeat (800)810-2583orcollectat(804)673-1177.
IF YOU TAKE A LEAVE
Allnon-registeredgraduatestudentswhoareonan approvedleaveofabsencearenotautomaticallyenrolledin UCSHIPbutmayenrollvoluntarily.Fordetailsonhowyou canenrollforUCSHIP,turntothesectionofthisbrochure called“Keeptrackofyoureligibility.”
YOUR
DENTAL
COVERAGE
INFO YOU’LL FIND IN THIS SECTION
Howtoenroll. . . .46 Youselectthepractitioner. . . .46 Whatiscovered. . . 47 Whatisnotcovered. . . .48FAQs
Am I automatically enrolled in the dental care plan?
Yes.EnrollmentinUCSHIPforregisteredgraduate studentsincludesdentalcoverage.
How do I find a dentist?
YoucanselectadentistfromtheDeltaDentalpreferred providernetworkofdentists.Thelistisavailableonline orbyphonethroughDeltaDentistCustomerService. YoumayalsouseadentistthatisnotpartoftheDelta Dentalpreferredprovidernetworkandpaymoretoward yourcare.Youdonotneedareferraltoreceivedentalcare. HOW TO ENROLL StudentscoveredbyUCSHIPareautomaticallyenrolled inthedentalplan.Youcanalsoenrolleligibledependents within31daysofthebeginningofeachcoverageperiod.
YOU SELECT THE PRACTITIONER
UCSHIPprovidescoverageundertheDeltaDentalPPO network.YoualsohavecoverageforotherDeltaDental dentistsandnon-networkdentists.Theplanpaysthe highestbenefitswhenyoureceiveservicesfromDelta DentalPPOdentists. DeltaDentalhasmanydifferenttypesofnetworks available,sobesureyouselectadentistfromthe DeltaDentalPPOnetwork.Youcanfindthislistonline atwww.deltadentalins.com/ucshiporcallDeltaDental CustomerServiceat(800)765-6003. Remember,ifyougotoadentistbelongingtoanother DeltaDentalnetwork,likeDeltaDentalPremier,your costswillbehigher.
WHAT IS COVERED
DeltaDentalsetsamaximumplanallowanceonthefeesfor eachtreatment.DeltaDentalPPOprovidershaveagreedto afeeschedule,butnon-networkprovidershavenot.
If your dentist charges more than the plan allowance for Delta Dental PPO services, you will be responsible for the full amount of the excess fees.
delta dental ppo network other delta dental networks or non-network
Fee schedule Agreed-toDelta
DentalPPO maximumallowed feeschedule Iffeesarehigher thantheDelta DentalPPO maximumallowed feeschedule,you paytheexcess
Annual deductible Noneforpreventive anddiagnostic services $25perpersonfor otherservices Nonefor preventive anddiagnostic services $50perpersonfor otherservices Preventive and diagnostic services 100% 80% • Oralexams • Cleanings(onceevery6months) • X-rays(onebite-wingserieswithin12 months) • Fluoridetreatment
Basic services 80%afteryoupay
deductible 60%afteryoupay deductible • Fillingsandextractions • Endodontics(rootcanal) • Periodontics • Oralsurgery
YOUR DENTAL COVERAGE
delta dental ppo network other delta dental networks or non-network
Major services 70%afteryoupay
deductible 40%afteryoupay deductible • Prosthodontics • Inlays/onlays • Crownsandcastrestorations Maxillofacial prosthetics and implants Notcovered Notcovered
Orthodontics Notcovered Notcovered
Annual benefit
maximums $1,000permember $750permember
Nottoexceedacumulativemaximum of$1,000perbenefityearforalldental benefits.
WHAT IS NOT COVERED
Someofthecategoriesofexpensesandservicesthatare excludedfromcoveragebyDeltaDentalarelistedbelow. Foracompletelistandfurtherdetails,readthefull descriptionofplanbenefitscalled“EvidenceofCoverage.” Findthedetailsatwww.ucop.edu/ucship.Clickon“Tellme moreaboutUCSHIP”andselectyourcampushomepage fromtheleft-handnavigationbar.Findthe“Description ofBenefits”link,then“EvidenceofCoverage.”You canalsocheckwithDeltaDentalCustomerServiceat (800)765-6003. Examplesofdentalplanexclusions: • Anesthesia,exceptforgeneralanesthesiaorIV sedationgivenbyalicenseddentistfororalsurgery servicesandselectendodonticandperiodontic procedures • Cosmeticsurgeryorsurgeryforconditionsthatarea resultofhereditaryordevelopmentaldefects • Diagnosticcasts • Occlusalguardsandcompleteocclusaladjustment • Replacementofexistingrestorationforanypurpose otherthanactivetoothdecay
YOUR
VISIONCARE
COVERAGE
INFO YOU’LL FIND IN THIS SECTION
Howtoenroll. . . 50 Youselecttheproviderforeyeexams,framesand contactlenses. . . 50 Whatiscovered. . . 51 Whatisnotcovered. . . 52 Beawiseuser . . . 52FAQs
Am I automatically enrolled in the vision care plan?
Yes.IfyouareagraduatestudentenrolledinUCSHIP,you arealsoenrolledinthevisioncareplan.
How can I make the most of my coverage?
Yourinsurancewillcoveragreaterportionofyourfeesif youreceiveexams,glassesorlensesfromaproviderinthe AnthemBlueViewVisionInsightnetwork. HOW TO ENROLL Youareautomaticallyenrolledinthevisioncareplan.You canenrolleligibledependentswithinthefirst31daysof eachcoverageperiodduringtheyear.
YOU SELECT THE PROVIDER FOR EYE EXAMS, FRAMES AND CONTACT LENSES
UCSHIPprovidesvisionplanbenefitsthroughtheAnthem BlueViewVisionInsightnetworkofproviders.Findafull listofprovidersnearyouatwww.ucop.edu/ucship.Click on“TellmemoreaboutUCSHIP”andselectyourcampus homepagefromtheleft-handnavigationbarandgoto “VisionServices.”OrcallAnthemBlueViewVisionat (866)940-8306.
WHAT IS COVERED Hereisabriefsummaryofyourvisionplanbenefits. Findafulllistofcoveredservicesnearyouat www.ucop.edu/ucship.Clickon“TellmemoreaboutUC SHIP,”selectyourcampushomepagefromtheleft-hand navigationbarandgoto“DescriptionofBenefits”where youwillfindalinkforthe“AnthemBlueViewVisionPlan.” anthem blue view vision insight network non-network
Routine eye exam (per benefit year)
$10copayment $49allowance
Eyeglass frames Youmayselectaneyeglassframeand receivethefollowingallowancetoward thepurchaseprice(perbenefityear) Upto$120,then memberpays 80%ofcosts exceeding$120 Upto$50, thenmember pays100%ofcosts exceeding$50 Eyeglass lenses (standard) • Singlelenses • Bifocallenses • Trifocallenses $25copayment $25copayment $25copayment Upto$35 Upto$49 Upto$74 Contact lenses (per benefit year)
Youmaychoosetoreceivecontact lensesinsteadofeyeglasslensesand receiveanallowancetowardthecostof asupplyofcontactlenses Conventional lenses Disposable lenses Upto$120; memberpays anythingabove $120lessa15% discount Upto$120 Upto$92 Upto$92
YOUR VISION CARE COVERAGE
WHAT IS NOT COVERED
ForacompletelistoftheitemsandservicesthatAnthem BlueViewVisionexcludes,readthefulldescriptionofplan benefitsatwww.ucop.edu/ucship.Clickon“Tellmemore aboutUCSHIP”andselectyourcampushomepagefrom thetheleft-handnavigationbarandgoto“Descriptionof Benefits”whereyouwillfindalinkforthe“BlueViewVision Plan.”YoucanalsocheckwithAnthemBlueViewVisionat (866)940-8306. BE A WISE USER Tomakethemostofyourcoverage,findin-networkAnthem BlueViewVisionInsightproviders.Ittakesjustaminuteto putmoremoneyintoyourpocket—moneyyoucanusefor lotsofotherpressingneeds. Andremembertocheckbeforeyoubuythosesunglassesor takethatstoreoffer.Theyareonthelistofitemsthataren’t covered,soyou’llpaythetotalcostoutofyourownpocket. Beforeyousayyestoyournextpurchase,makeaquick checkatthewww.ucop.edu/ucshiphomepageforyour campusorcallAnthemBlueViewVisionat(866)940-8306.
OPTIONALUCSHIP
BENEFITSFOR
INFO YOU’LL FIND IN THIS SECTION
Ifyouelectdependentcoverage,UCSHIPcoversmedical, dentalandvisioncare . . . 55 Studentshavedependentsofallages. . . 55 Howtoenroll. . . 55 UCSHIPdependentmedicalcoverageisdifferentfrom thestudentplan . . . 55 Tobepaid,medicalservicesmustbeobtainedfrom AnthemBlueCrossnetworkproviders . . . 56 Ifthereisanemergency. . . 56 Annualdeductible. . . 56 Annuallimitonyourout-of-pocketcosts. . . 56 Whatiscovered. . . 57 UCSHIPdependentdentalandvisionplansarethesame asthestudentplans. . . 57FAQs
When do I purchase dependent insurance?
GraduatestudentscoveredunderUCSHIPmayenroll eligibledependentswithinthefirst31daysofeachcoverage periodinthebenefityear.Dependentsmustbere-enrolled eachcoverageperiodduringtheyear,typicallyatthestart ofeachsemesterorquarter.
How should I handle emergency care for my covered dependents?
Goimmediatelytothenearestemergencydepartmentor urgentcareclinicforcare.ThencallAnthemBlueCross within48hoursforauthorizationusingthetelephone numberlistedonthedependent’sIDcard.
IF YOU ELECT DEPENDENT COVERAGE, UC SHIP COVERS MEDICAL, DENTAL AND VISION CARE
UCSHIPisproudtoofferbroad,affordabledependent coverageoptionstoourstudents.Dependentsofstudents enrolledinUCSHIPcanbesignedupwithinthefirst 31daysofeachcoverageperiodduringthebenefityear. Dependentscanbeenrolledineithermedicalonlyor medical/dental/visionasapackage.
STUDENTS HAVE DEPENDENTS OF ALL AGES
Dependentsinclude: • Aspouseorsame-sexdomesticpartner • Anopposite-sexdomesticpartner,ifoneorboth partnersareage62oroverandeligibleforSocial Securitybenefitsbasedonage • Unmarriednatural-bornoradoptedchildrenuptoage26 • Unmarriedadultchildrenovertheageof26ifchiefly dependentonthestudent,spouseordomesticpartner forsupportandincapableofsustainingemployment duetoaphysicalormentalcondition • Unmarriedfosterchildrenuptoage18 TobecoveredbyUCSHIP,anewbornshouldbeenrolledas adependentwithin31daysofbirth. HOW TO ENROLL GraduatestudentsenrolledinUCSHIPmayenroll theireligibledependentswithinthefirst31daysofeach coverageperiodor,fornewborns,within31daysofbirth,by contactingWellsFargoInsuranceServicesat(800)853-5899 topurchasedependentinsurance. Thereareotherlifeeventslikemarriageandadoption thatmayenableyoutoenrolldependents.Checkthe BenefitBookletthatyoucanfindonwww.ucop.edu/ucship forthedetails.
UC SHIP DEPENDENT MEDICAL COVERAGE IS DIFFERENT FROM THE STUDENT PLAN
Fordependents,UCSHIPcoverageinvolvesanexclusive providerorganizationcalledtheAnthemBlueCross PrudentBuyernetworkofproviders.Dependentsarenot eligibleforservicesattheSHC.Also,dependentcoverage
OPTIONAL UC SHIP BENEFITS FOR DEPENDENTS
TO BE PAID, MEDICAL SERVICES MUST BE OBTAINED FROM ANTHEM BLUE CROSS NETWORK PROVIDERS
DependentsmustuseAnthemBlueCrossPPOPrudent BuyernetworkproviderstobecoveredunderUCSHIP, exceptinanemergency.Theplanpaysclaimsonlyfor medicalservicesobtainedfromamemberoftheExclusive ProviderOrganizationorbecauseamemberofthe ExclusiveProviderOrganizationhasprovidedwritten authorizationtogoout-of-networkforcare. Claimpaymentsarebasedonthemaximumallowed amountsdeterminedbyAnthemBlueCross. IF THERE IS AN EMERGENCY Inanemergencyorout-of-areaurgentcaresituation, goimmediatelytothenearestfacilityforcare.Thencall AnthemBlueCrosswithin48hoursforauthorization usingthetelephonenumberlistedonthedependent’sID card.Inpatientcarereceivedfromanon-networkhospital withoutanauthorizationfromAnthemBlueCrossis coveredonlyforthefirst48hours.Coveragewillcontinue beyond48hoursifthemembercannotbemovedsafely. ANNUAL DEDUCTIBLE Eachplanmemberpaysanannual$400deductibletoward coveredservicesbeforetheplanpaysbenefits.Someservices likepharmaceuticalsarecoveredimmediately,though.See thesummaryofbenefitsinthesectionbelowforinformation aboutservicesforwhichthedeductibleiswaived.
ANNUAL LIMIT ON YOUR OUT-OF-POCKET COSTS
Theannualdependentcoinsuranceout-of-pocketmaximum is$6,000foreachcovereddependent.Theout-of-pocket maximumdoesnotapplytoset-dollarcopayments, amountsexceedingstatedbenefitlimitsortoservicesnot coveredbytheplan. WHAT IS COVERED Hereisabriefsummaryoftheservicesthatarecovered whenyourdependentsreceivecarethroughtheAnthem BlueCrossExclusiveProviderOrganization.Afulllistof coveredservicescanbefoundatwww.ucop.edu/ucship. Clickon“TellmemoreaboutUCSHIP”andselectyour campushomepageand“DescriptionofBenefits”tofind your“BenefitBooklet.”
KeepinmindthatAnthemBlueCrosssetsallowed maximumsforservicesprovidedbynetworkproviders. Thefollowingbenefitsummaryliststhepercentageof theallowedmaximumsthattheplanpays.Forexample,if thesummarylistscoverageat80%andthereisa$100.00 allowedmaximumforatreatment,thentheplanpays $80.00towardthebill.
THE ANNUAL DEDUCTIBLE APPLIES TO ALL SERVICES LISTED BELOW, EXCEPT WHERE NOTED
SUMMARY OF DEPENDENT COVERAGE
Medical office visits 80%
Routine physicals/adult preventive care
100%,deductiblewaived
Mammograms, preventive 100%,deductiblewaived
Lab tests, X-rays and imaging 80%
Outpatient surgery 80%forservicesofphysicians andanesthesiologistsand foroutpatientsurgerycenter facilities
Inpatient surgery 80%
UC SHIP DEPENDENT DENTAL AND VISION PLANS ARE THE SAME AS THE STUDENT PLANS
DentalcoverageisprovidedbyDeltaDental,asdescribed onpage46.VisioncoverageisprovidedbyAnthemBlue ViewVision,asdescribedonpage50.
OPTIONAL UC SHIP BENEFITS FOR DEPENDENTS
DEFINITIONSOF
INSURANCETERMS
Ancillary Services Servicesrenderedbyhealthcare
providersotherthanaphysician,suchaslaboratory, radiologyorotherdiagnosticimaging,physicaltherapy, orotherservices.
Benefit Year Thetimeperiod,usuallytheacademicyear,
usedtodeterminewhenyousatisfyyourannualdeductible, benefitmaximums,andannualout-of-pocketmaximum. Coinsurance Coinsurancereferstocostsharingbasedon apercentageofthemaximumallowedamount(covered expense)chargedforacoveredservice.Theinsurance companypaysacertainpercentageofcoveredexpense andyou,theinsured,paytheremainingexpense. Copayment Theset-dollaramountthatacoveredperson mustpayforacoveredservice,usuallydueatthetimethe serviceisprovided.Officevisitcopaymentsdonotcount towardyourannualdeductible. Deductible Theamountofmoneythecoveredpersonis requiredtopayoutofpocketbeforetheinsurancecarrier willpayforservices. Emergency Anemergencyisasudden,seriousand unexpectedacuteillness,injuryorcondition(including suddenandunexpectedseverepain)thatyoureasonably perceivecouldpermanentlyendangeryourhealthifmedical treatmentisnotreceivedimmediately.AnthemBlueCross makesthesoleandfinaldeterminationastowhether serviceswererenderedinconnectionwithanemergency. Inpatient Apatientwhoisadmittedtothehospital. Maximum AllowedAmount Thetotalreimbursement
payableunderyourplanforcoveredservicesyoureceive fromnetworkandnon-networkproviders.Itistheclaims administrator’spaymenttowardtheservicesbilledbyyour providercombinedwithanydeductibleorcoinsurance owedbyyou.Ifservicesareobtainedfromanon-network provider,theproviderwillbillyouthedifference,ifany, betweentheirchargesandthemaximumallowedamount.
Preferred Provider Organization (PPO) Agroupof
medicalproviderswhocontractwithaninsurancecarrier toprovideservicesfortheinsuredatreducedrates.
HOW TO GET IN TOUCH WITH THE SHC, UC SHIP AND YOUR INSURANCE CARRIERS
Regularhoursofoperationaresubjecttochangeduringholidays, examperiodsandacademicbreakperiods.ChecktheSHCwebsite forupdates. Emergency: 911 Counseling Center www.chs.uci.edu (949)824-6457
Student Health Center (SHC)
501StudentHealth Irvine,CA92697-5200
www.shc.uci.edu
Monday through Friday 8:00 a.m. to 5:00 p.m.
Medical Specialty Clinics
Availablebyappointment.Checkwith theSHCtoseeifyouneedareferral. • Gynecology • InternalMedicine • Dermatology • Ear,NoseandThroat • MinorSurgery • Orthopedics/SportsMedicine Nurse Clinics • PatientEducation • Immunizations • TuberculosisScreening • TravelMedicineAdvice
Anthem Blue Cross 24/7 NurseLine
(877)351-3457
Anthem Blue Cross and
Blue View Vision Customer Service
www.ucop.edu/ucship (866)940-8306
Ventegra Pharmacy Services
www.ventegra.net (877)867-0943
Delta Dental Customer Service
www.deltadentalins.com/ucship (800)765-6003
Wells Fargo Insurance Services Customer Care
for UC SHIP Voluntary Student and Dependent Coverage
(800)853-5899 SHC Departments Appointments (949)824-5304 Insurance (949)824-2388 Insurance Fax (949)824-5062 Pharmacy (949)824-5923 Radiology (949)824-5812 Psychiatry (949)824-1835 Dental Clinic (949)824-5307 Administration (949)824-7010 Business Office (949)824-7744 General Information (949)824-5301 Health Education (949)824-5806 Medical Records (949)824-9634 Medical Records Fax (949)824-3033 Patient Billing Services (949)824-8098 Volunteer Office (949)824-3500
If you need care, start at the SHC
Exception: No referral is needed for
emergency care and urgent care
SHC: Student Health Center
* Benefits will not be paid without an SHC referral
If you need care outside the SHC,
your SHC clinician will provide
a referral *
To keep your costs low, go to
an Anthem Network Provider
when you receive your referral
If you have questions, call the SHC
or Anthem Customer Service at
(866) 940-8306
UC SHIP Health Card Logo 4/22/13
This brochure provides a summary of information. For complete information on all benefits, terms and conditions of UC SHIP, see the Benefit Booklet at
www.ucop.edu/ucship. Click on “Tell me more about UC SHIP,” select your campus home page from the left-hand navigation bar and click on “Description of Benefits” to find the “Benefit Booklet.”
AnthemBlueCrossLifeandHealthInsuranceCompanyprovidesadministrativeservices onlyanddoesnotassumeanyfinancialriskorobligationwithrespecttoclaims.Blue CrossofCalifornia,usingthetradenameAnthemBlueCross,administersclaimson behalfofAnthemBlueCrossLifeandHealthInsuranceCompanyandisnotliablefor benefitspayable.IndependentlicenseesoftheBlueCrossAssociation®ANTHEMisa registeredtrademarkofAnthemInsuranceCompanies,Inc.TheBlueCrossnameand symbolareregisteredmarksoftheBlueCrossAssociation.
