Voluntary and Dependent Enrollment 2018 - 2019

Undergraduate Students

Voluntary enrollment in UCSHIP for undergraduate students is managed by USI Insurance Services (USI) for medical, dental and vision plans. The cost of insurance premiums for voluntary coverage is paid directly to USI.

To enroll in the Medical, Dental and Vision Plans:


USI Insurance Services, Inc
(800) 853-5899
Fax: (877) 612-7966
10940 White Rock Road, 2nd Floor
Rancho Cordova, CA 95670

Voluntary UCSHIP Undergraduate Enrollment Forms:

Enrollment Form for Undergraduate 2018 Summer Sessions

Enrollment Form for Voluntary Undergraduate Medical, Dental and Vision Plans


Graduate Students

Voluntary enrollment for Graduate Students in UC SHIP is managed by USI Insurance Services (on behalf of UC SHIP/UCOP and all carriers). In addition, the cost of insurance premiums for voluntary enrollment is paid directly to USI Insurance Services (USI).

To enroll in the Medical, Dental and Vision Plans:

USI Insurance Services, Inc
(800) 853-5899
Fax: (877) 612-7966
10940 White Rock Road, 2nd Floor
Rancho Cordova, CA 95670

Voluntary UCSHIP Graduate Enrollment Forms:

Enrollment Form for Voluntary Graduate Medical, Dental and Vision Plans

Enrollment for Voluntary Graduate Dependent Medical, Vision and Dental Plans


Approved Leave of Absence

All UC Santa Barbara students who are on an "approved leave of absence" may purchase UC Student Health Insurance Plan coverage per quarter for a maximum of two quarters by contact USI Insurance Services Inc at (800) 853-5899 and enroll within 31 days of the first day of the quarter.

The student must have been covered by UC SHIP in the term immediately preceding the term for which the student wants to purchase coverage, or, if the student waived enrollment in the prior coverage period, show proof of loss of the plan used to waive. Proof of loss means an official letter of termination from the insurance carrier. Please use the enrollment form that corresponds to your academic program based upon either the quarter or semester system.

Dependent Enrollment

Coverage of eligible dependents will not be effective prior to that of the insured student or extended beyond that of the insured student. Dependent enrollment or re-enrollment in the plan is not automatic. Eligible dependents must be re-enrolled in each subsequent term in order to continue coverage under the dependent plan. If a student decides to dis-enroll their dependent(s) during an academic term, then the premiums are non-refundable. Dependents are not eligible to receive services at the Student Health Service and they do not need a referral from SHS to receive medical services from community providers.

Documentation to Show Proof of Dependent Status

Students are required to provide proof of dependent status when enrolling their dependents in the plan. The following documents are acceptable:

  • Spouse - marriage certificate
  • Same-Sex Domestic Partner - a Declaration of Domestic partnership issued by the State of California, or of same-sex legal union other than marriage formed in another jurisdiction, or a completed declaration of Domestic Partnership Form issued by the University
  • Natural Child - a birth certificate showing the student is the parent of the child
  • Stepchild - a birth certificate and a marriage certificate showing that one of the parents listed in the birth certificate is married to the student
  • Adopted or Foster Child - documentation from the placement agency showing that the student has the legal right to control the child's health care


Voluntary Coverage Enrollment Periods and Costs

Leave of Absence (LOA) and Dependents Enrollment Periods:

Fall Enrollment Period:         07/27/2018 – 10/23/2018
Winter Enrollment Period:
 11/01/2018 – 01/31/2019
Spring/Summer Enrollment Period:
03/01/2019 – 05/02/2019

Costs of Enrollment in Dependent Coverage:

Spouse/Domestic Partner:
Fall:       $968.40
Winter:  $968.40
Spring:  $968.40

Child(ren):
Fall:       $968.80
Winter:  $968.80
Spring:  $968.80

Spouse/Domestic Partner + Child(ren):
Fall:       $1,064.41
Winter:  $1,064.41
Spring:  $1,064.41