|When you need health care:
|With UC SHIP, all care must begin at Student Health (SH). When you need medical care, you may go online or call to make an appointment. There are no claims to file for SH visits.
|Referrals from SH clinicians
||If you need services at another health care facility or physician's office, your SH clinician will make the referral. You must have non-urgent outside appointments pre-authorized by the Insurance Office. Off-campus care (care outside of UCSB Student Health) is coordinated by SH clinicians, and the UC SHIP staff will provide referrals for covered services and ensure that your claims are handled accurately.
For off-campus care, UC SHIP contracts with an extensive network of hospitals and providers. If providers or facilities are used that are not part of the Network, your claims will be paid at a percentage of the "limited fee schedule," which is often significantly lower than the network rate.
To find a provider, you can call the customer service number on the back of your health insurance card, or go to the UC SHIP web site.
No authorization from the Student Health Insurance Office is required for visits to an emergency room or urgent care center. Please provide facility with your UC SHIP insurance card. Claims submitted to UC SHIP will be processed according to the UC SHIP benefits.
All follow-up care must be authorized in advance by the Student Health Insurance Office.
| When you are out of the 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 805-893-2592 or email email@example.com for a referral. UC SHIP covers care worldwide. See Using UC SHIP Abroad
||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 SH must receive prior referral an/or authorization or your claim may not be paid.
Services outside SH that do not require pre-authorization include:
- Services provided in a hospital emergency room
- Prescriptions filled outside of SH
- Chiropractic services
- Out of California
For all other non-emergency medical care outside SH, bring medical referrals to Student Health Insurance Office.
|Billing for services at SH
||UC SHIP members do not file a claim for services at SH that have fees. At the time of service, patient fees and/or co-payments for which they are responsible will be applied to their BARC account. SH will then file a claim with UC SHIP for payment of the remainder of the charges.
|Billing for services outside SH
||When students receive care outside of Student Health, the health care provider may require the co-payment 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 UC SHIP. Claims must be submitted within 12 months of the date of service.
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 UC 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.
To ensure proper payment or reimbursement of your claim, make sure you get an itemized bill from the provider. An itemized bill includes:
- Provider's name, address, and tax identification number. Individual providers must also include their professional license number.
- Patient's name, address, date of birth, and your perm ID number.
- Dates of service.
- Procedure codes for services rendered
- Charges for each service.
- 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 SH, 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: Expect to receive an Explanation of Benefits from UC SHIP 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 (805) 893-2592 for assistance. You may also call Anthem Blue Cross directly at (800) 888-2108.
Remember: It is very important that you keep your address updated! This is how we know your address for reimbursement. When you move or go away for the summer, please remember to update your address with the Registrar's office.
||There is a $200 plan year deductible for most services provided outside SH. UC SHIP members are responsible for the first $200 of charges each plan year. Once the deductible has been satisfied, UC SHIP benefits begin. Services provided at SH, pharmacy and outpatient co-payments, including outside psychotherapy, are not subject to the $200.00 deductible.
Amounts over the "limited fee schedule" as determined by UCSHIP do not accumulate toward the deductible.
||Services provided at SH will be billed exclusively to UC SHIP regardless of whether you have dual coverage through another plan in addition to UC SHIP. For services provided outside of SH, 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, UC SHIP may ask you for information about your other plan.
|Annual out-of-pocket maximum
||Students are responsible for no more than $3,000 of out-of-pocket in-network expenses each plan year (which includes the $200.00 plan year deductible). If you have paid $3,000 in co-insurance and deductibles (not including Pharmacy any other co-payments), you will no longer be required to pay co-insurance for the remainder of the plan year. The out-of-pocket maximum for out-of-network expenses is $6,000. 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.
|Managing your plan
Updated address: It is very important that you keep your address updated. This is how UC SHIP knows your address. When you move or go away for the summer, please remember to update your address with the Office of the Registrar.