HOW TO...
UCSB Graduate Student Health Insurance (GSHIP)
2008-2009 Academic Year
ACCESS CARE IN CALIFORNIA
If you are within a 50-mile radius of the Student Health Service (SHS), you must visit SHS before seeing an outside provider except in the case of emergency (see below.) SHS is your primary care provider, and normal hours are Monday through Friday 8:00 a.m. ? 4:30 p.m. except Wednesdays, when SHS opens at 9:00 a.m. There are extended hours on Thursday until 7:00 p.m. for appointments only. Please check the brochure (www.sa.ucsb.edu/studenthealth/insurance) for dates and times of closures for this academic year:
If you are more than fifty miles from UCSB, you may go to the provider of choice. Please remember that reimbursement is at 80% of a discounted rate for eligible benefits if you visit a member of the Preferred Provider Organization vs. 50% of a non-adjusted rate for a provider who is not a member of the network. For Preferred Providers, access www.cfmcnet.org or call (800) 877-1444. Or, you can call the claims administrators (PIA) to receive names of preferred providers in the area in which you are accessing care.
Claims Administrator:
Personal Insurance Administrators (PIA)
PO BOX 6040
Agoura Hills, CA 91376-6040
Phone: (800) 468-4343
FAX number: (818) 735-3567
Students on Approved Leave
If you are on approved leave and have enrolled in GSHIP, you have paid $33 more per leave quarter for insurance which covers practitioner visits at Student Health. These charges are necessary, as a non-student does not pay the fees that help fund SHS.
Dependent Charges
Dependents are charged per visit when they come to Student Health Service. This is an eligible benefit, and an Insurance Advisor will assist you in filing your claim for this and any other charges that you acquired at SHS.
Referred outside of SHS
If you require more specialized care than can be provided at SHS, you will receive a written referral, which you will take to an outside practitioner.
Submitting claim forms
Members of the network have agreed to bill the insurance company. You must file a claim form for each condition. Claim forms may be downloaded from the SHS website:
or you may pick one up in the SHS lobby or file online at PIAclaims.com. If referred from SHS, please take a completed claim form with you to your appointment and ask the provider to submit it to PIA along with the bill and referral form. We suggest that you also send a copy directly to PIA and keep a copy for yourself.
Emergencies
If you have an emergency situation, you may visit the nearest emergency facility. You can locate emergency service locations by accessing the Student Health Service website:
or by looking in the telephone book. If within a 50-mile radius of UCSB SHS and SHS is closed, you will be reimbursed at 100% of eligible benefits if admitted to the hospital from the emergency facility. If SHS is open or if you are outside of this radius, your reimbursement will be at 80% of eligible benefits. Always call SHS within one business day following an emergency visit. Follow-up care must be received at SHS unless the service is not provided at this facility or if you are outside the 50-mile radius. There is a $100 deductible per ER visit. If you do not have an emergent situation and Student Health is closed, try a visit an Urgent Care facility (see brochure for definition of emergency). This will save you out-of-pocket costs.
If medication is prescribed, you should ask the emergency/urgent care facility to provide you with enough to last until you can visit the SHS pharmacy the following day. If SHS will be closed the following day, you may have your prescription filled at another pharmacy. Prescriptions will be reimbursed at 100% (after a $25 copayment and the deductible has been satisfied) if SHS does not carry the medicine or if SHS Pharmacy is closed on that day or if you are outside a 50-mile radius.
Carry your insurance identification
Always carry your insurance identification card with you. Identification cards are available online at www.sa.ucsb.edu/studenthealth/insurance or you may request one from an Insurance Advisor in the SHS lobby. There is also a temporary identification card at the back of the brochure which also available at the Student Health website.
ACCESS CARE OUT OF STATE/COUNTRY
Carry your insurance identification
If you plan on being out of the state or out of the country for an extended period of time, make sure that you take along a claim form and that you carry your insurance identification card with you at all times. There is a preferred provider network outside of California throughout the United States. Call the claims administrators (PIA) to receive names of preferred providers in the area in which you are accessing care. PIA: (800) 468-4343.
File your claim promptly
Members of the Preferred Provider Organizations have agreed to directly bill the insurance company for charges. If you are outside of the country, there is no preferred provider network, so it is very likely that the provider will require payment at the time of service. This is why you want to carry a claim form with you. The sooner you submit the completed form with your receipt to the claims administrators (PIA), the sooner you will receive reimbursement.
Your insurance plan has a Stop Loss clause. Once eligible out-of-pocket expenses exceed $4,000 in an academic year (or $5,000 for out-of-network services), the insurance company will pay the remainder of expenses at 100%. You will only be responsible for $4,000. You may wish to contact the provider to discuss the possibility of payment arrangements.
Prescription medications
Prescriptions are covered at 100% (minus a $25 copayment and after deductible has been satisfied) when filled more than fifty miles from SHS. You must submit a claim form with your receipt to get reimbursed.
If you know before you leave that you will need certain medications, request your practitioner to write a prescription for a larger amount. You are eligible to purchase medication for the period of time for which you have paid for insurance. So, at the beginning of the plan year in September, you may purchase a 90-day supply because you have paid for Fall Quarter insurance (through December.) If it is October, you may purchase only two months worth, etc.
Contact American Consulate
If you are experiencing difficulties accessing adequate care, please contact the American Consulate in the country in which you are visiting.
Emergency Medical Services, Evacuation, Repatriation
As an insured member of GSHIP you are automatically enrolled as a Member in the MEDEX program. MEDEX provides assistance for emergency medical services and evacuations. This includes emergency medications, legal assistance, translation services and more. Please see your brochure for a full explanation of these services. The 24-hour toll-free (or collect call) numbers for assistance are (800) 527-0218 or (410) 453-6330
RECEIVE HELP WITH CLAIM PROBLEMS
Submit claim for each condition
A claim form must be submitted for each condition. You may download a claim form from the Student Health Service (SHS) website:
www.sa.ucsb.edu/studenthealth/insurance
or pick one up in the SHS lobby from an Insurance Advisor or from the Help Kiosk or you may file a claim online at PIAclaims.com. Complete the form, sign it, and mail to PIA, the claims administrator.
Explanation of Benefits
After you have submitted a claim form, you will receive an Explanation of Benefits (EOB) from PIA. This document will itemize your benefits, including your deductible ($300 per academic year), if applicable. If you have received a bill from a provider but not an EOB from PIA you can call PIA to check on the status of your claim or check online at www.PIAclaims.com. The Insurance Advisors also have computer access to your EOB and can discuss it with you and, if necessary, print a copy for you. If you do not understand how to interpret the EOB, please call an Insurance Advisor at (805) 893-2592. If you have a specific question regarding a benefit, please call PIA and ask for Customer Service. Always have your EOB and/or your bill accessible when you call for assistance.
Additional information required
If you did not thoroughly complete your claim form, you may receive a letter from PIA requesting specific information. They may need a referral form or information on other insurance or on pre-existing conditions. Return this information to them as soon as possible. If you have received a referral from SHS and PIA requests such a form, please call SHS Medical Records department [(805) 893-2018] and request that a copy of the referral be submitted to PIA.
Still having claim difficulties
If you have followed these procedures and you continue to have difficulty with your claim, please call the Insurance Coordinator, Elaine Grimmesey, at (805) 893-6133.
Insurance Forms
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One stop only!
- Check Claim Status
- Claim Forms
- Enrollment Forms
- Identification cards
- Online Claim Submission
- Preferred Provider Lists
- USHIP/GSHIP Policies
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Undergraduate Forms and Information
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Graduate Forms and Information
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