QUESTIONS AND ANSWERS
Graduate Student Health Insurance Plan (GSHIP)
2007-2008
Health Insurance is mandatory for all graduate students at UCSB. You will automatically be enrolled in GSHIP unless you waive out. The plan year dates are September 23, 2007 through September 21, 2008, with premiums paid three times a year. Dependents must enroll four times per year - the enrollment form is in the back of the brochure. If you have comparable independent insurance coverage and can access primary care within 25 miles of UCSB, you may submit a Waiver Request form to waive out of GSHIP. Please read the brochure for a full understanding of benefits. Your identification card may be printed from the website in September. It should be carried with you at all times. Insurance information, including the brochure, waiver request form and claim form, are available from the Student Health Service (SHS) website at:
Also available at this website is a “How To…” document for graduate insurance. It is suggested that you read this document in conjunction with this Question and Answer text.
What’s new for 2007-2008 (by graduate student vote)
- $300,000 maximum benefit per condition, renewable annually
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- $300 annual deductible, $100 per visit emergency room deductible
Cost:
Students: $678/quarter; the annual cost is $2,034.
Students on Approved Leave: $711/quarter
Spouse/domestic partner: $1541/quarter (paid four times a year)
Spouse/domestic partner & children: $2,333 quarter (paid four times a year)
Child(ren): $799/quarter (paid four times a year)
How do I access healthcare?
Please see the companion document entitled “How to…” for details on how to access health care locally and worldwide. Also included in that document is information on how to deal with problems with medical bills.
What is a deductible?
A deductible is the amount of money for which you are responsible before the insurance company pays any eligible expenses. You have a $300 deductible per academic year, September to September. The deductible requirement begins again with the new plan year (each September). There is also a $100 per visit emergency room deductible.
What is coinsurance?
Coinsurance is the portion for which you are responsible after your deductible has been satisfied. If you have already satisfied your $300 deductible and your total bill is $200, 20% coinsurance amounts to $40; 50% coinsurance is $100.
What is a copayment?
A copayment is a predetermined charge that you pay for a particular service. Your pharmacy copayment is $25 for a 30-day supply of a prescribed medication. If the prescription costs less than $25 and is filled at SHS, only the cost of the prescription is charged.
What is the Foundation for Medical Care?
The Foundation for Medical Care is the Preferred Provider Organization (PPO) for GSHIP. It is a regionally divided, statewide-managed care group that contracts with hospitals and physicians for reduced member rates. Members have access to any Foundation provider in the state of California. If within a 50-mile radius of UCSB, you must first visit Student Health Service (except in case of an emergency.) If medical services are required that SHS cannot provide, you will be referred to an outside provider. You may pick up a list of local PPO providers from an Insurance Advisor in SHS or print from www.cfmcnet.org. After your deductible has been met, you are eligible for 80% reimbursement only when you visit a member of the Foundation – 50% when a provider is not a member of the Foundation (except in emergencies.) You are responsible for any additional charges not covered by your policy. It is your responsibility to verify your charges. Reimbursement is based on eligible expenses. Please see the GSHIP brochure for more details about the Foundation and for a definition of eligible expenses.
What is Beech Street?
Beech Street is the Preferred Provider Organization (PPO) for GSHIP outside of California. Members have access to any Beech Street provider in the nation. The number of this organization is on your identification card. The same benefits apply as with the Foundation for Medical Care network (see details in question immediately above this one.)
How much do I pay for my prescription medication?
There is a $25 copayment for a 30-day prescription, $40 for 60 days and $50 for 90 days. After this copayment, coverage is as follows:
- 100% if filled at the SHS
- 100% if filled outside of SHS if the medication is not carried at SHS
- 100% if filled outside of SHS if SHS is closed on that day
- 100% if filled more than fifty miles from UCSB
- 50% if filled outside SHS for convenience
The pre-existing condition clause and the necessity of satisfying your deductible do not apply if your prescription is filled at SHS, if SHS does not carry the medication, or if you are outside a 50-mile radius of SHS.
If your prescription is filled outside of SHS, you will have to pay the full cost of the medication. To receive reimbursement, you must send your receipt, a claim form and a note stating the medication is not available at SHS (if applicable) to the claims administrators (PIA.)
Is there a monetary limit to what the insurance will pay?
There is a $300,000 maximum benefit for each accident or illness, renewable each plan year. There is a $5,000 per year maximum prescription benefit.
Is there a monetary limit to what I will have to pay?
Yes. There is a $4,000 “stop loss” benefit, which means that after you have paid $4,000 in out-of-pocket eligible expenses (coinsurance, copayments, deductible all included), the insurance company will pay all eligible expenses above this amount up to the relevant benefit maximum, if you use only network providers. This amount increases to $5,000 if out-of-network providers are used.
Does Student Health Service bill the insurance company for me?
No, Student Health Service provides no insurance billing (except for dependents who have met their $500 deductible and for all prescriptions filled at SHS.) All PPO providers outside of SHS, however, have agreed to bill the insurance company. You are responsible for submitting a claim form to the claims administrators (PIA) for each eligible medical expense. You may submit a claim online at www.PIAclaims.com. Another option would be to complete a claim form available at http://studenthealth.sa.ucsb.edu/Insurance If you have questions, please contact an Insurance Advisor at (805) 893-2592 or email: Insurance@sa.ucsb.edu.
Am I covered during the summer and during school breaks?
Yes. The Spring Quarter insurance premium for graduate students provides coverage throughout the summer until the new policy begins in September. A dependent must enroll for each term in which they wish to be enrolled, including summer.
Does my insurance cover routine eye and dental care?
Student Health has a vision plan that provides discounts for routine vision care. Care for medical conditions affecting your eyes is covered under your medical plan. Please refer to the online brochure for specifics regarding this coverage. Your insurance covers accidental injury to natural teeth (see brochure), and includes a SHS administered dental plan. The $38.25 quarterly charge for this plan is built into your GSHIP fees. For no additional charge, you received one annual exam with x-rays and two routine cleanings per year with a $15 copayment for each. For details, please see the SHS Graduate Dental Clinic Plan pages in your brochure. The Dental Clinic plan applies to graduate students only, as spouses/dependents are not seen in the SHS Dental Clinic.
Is Physical Therapy covered?
Physical Therapy is covered at 100% up to a maximum of $500 per condition per year if received at Student Health Service, and the post- surgical requirement does not apply. SHS has a high-quality Physical Therapy Department that you may access with a referral from a practitioner. Physical Therapy services received at a facility outside of SHS are covered post-surgically only, with benefits at either 80% (PPO) or 50% (non-PPO) up to a maximum of $500 per condition per year.
Is pregnancy covered?
Yes, pregnancy is covered at the same benefit level as any other medical condition. New California Code mandates that the six-month pre-existing clause does not apply to “a group health plan….relating to benefits for pregnancy or maternity care. If you are pregnant before you enroll in GSHIP and have not been covered by a comparable insurance plan, you will now receive benefits from your enrollment date. A newborn baby is covered for any illness or accident for 31 days. A newborn’ s nursery stay is an eligible benefit. To continue a newborn’s coverage beyond 31 days, you must enroll him/her in the insurance plan whether or not an additional premium is required.
Do adult dependents enrolled in GSHIP have to first be seen at Student Health Service?
Yes, unless they are more than fifty miles from UCSB. There is a visit fee charge for all non-students using SHS. This fee is an eligible insurance benefit and you will need to file a claim form with the claims administrators (PIA). Children are not seen at SHS, so if your child is covered by this insurance and becomes ill, has an accident, or needs recommended well-baby immunizations, you may go to a provider of your choice. Remember, reimbursement is at 80% for a provider/facility who is a member of the Foundation for Medical Care and 50% if the provider/facility is not a member.
The premiums for dependents are way too high. What are my choices?
No one is denied enrollment in GSHIP; therefore, often people who know that they will be high utilizers enroll in the plan. This causes elevated insurance rates. You may choose to call an independent company to inquire about their rates for your dependents or access the website http://www.ehealthinsurance.com/ehi/index.html for other insurance options.
Can I purchase this insurance if I am on approved leave?
Yes. You must send an enrollment application (in your brochure), your payment and a copy of your approved leave document to Renaissance Agencies. The premium for students on leave is slightly higher than for registered students as SHS does not receive operating funds for non-registered students. You may enroll in GSHIP for no more than four quarters total (please note the Spring term counts as two quarters as it includes summer) while on approved leave. The quarters need not be contiguous. Remember – you are not automatically enrolled in GSHIP unless you are a fully paid, registered student.
What if I require emergency medical attention in a foreign country?
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, if necessary. 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
What if I am a new student and my department requires me to be in Santa Barbara prior to the September 24 beginning plan date?
If you are required to be in Santa Barbara before September 23 for matriculation purposes, either bring University documentation to that effect to the SHS insurance office or have your department e-mail this request to the Insurance Coordinator Grimmesey-e@sa.ucsb.edu and your coverage may begin early, but not prior to September 1.
What can we do as students to help keep the insurance premiums down?
This is important, because the more expensive the service the higher the premium will be for next year. You can do four things: 1) Utilize the Student Health Service, 2) Avoid referrals of convenience, 3) Use preferred providers whenever possible and 4) Utilize Urgent Care Centers vs. Emergency Rooms when applicable if SHS is closed. See brochure for definition of emergency.
I don’t have time to read the GSHIP brochure – how can I get more information and have my questions answered?
While we are happy to answer your questions, it is YOUR RESPONSIBILITY to read the information provided in order for you to have a good understanding of your policy and its benefits, limitations and exclusions. GSHIP brochures and claim forms are available at SHS and from the Website http://studenthealth.sa.ucsb.edu/Insurance. If you do have questions, you may call the claims administrators (PIA) directly (1 800-468-4343), or email I have concerns with various aspects of GSHIP. With whom may I talk?
The Graduate Students Association meets, discusses, negotiates and votes on each phase of GSHIP. These meetings occur monthly during the school year, and anyone interested is welcome to attend. To ascertain dates and times and/or to place an item on the agenda, please the GSA GSHIP Committee by calling the GSA at
(805) 893-3824, sending an email to gsa@sa.ucsb.edu, or visiting the GSA website at http://www.gsa.ucsb.edu to find the names and contact information for GSA representatives to the GSHIP Committee. You may also contact the SHS Insurance Coordinator, Elaine Grimmesey, at (805) 893-6133, or by e-mail at Grimmesey-e@sa.ucsb.edu.
I’m graduating. How can I document that I have had continuous insurance coverage?
You may request, either in writing or by phone, a Certification of Group Health Plan Coverage from
Renaissance Agencies, Inc.
P.O. Box 2300
Santa Monica, California 90407-2300
Phone: (800) 537-1777
If you enroll in a new plan within 63 days of termination of coverage, no pre-existing clause will apply. You will need the Certificate of Coverage to verify your enrollment in GSHIP.
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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