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Voluntary and Dependent Enrollment 2019 - 2020

Dependent Coverage

Undergraduate and Graduate students who are enrolled in UC SHIP have the option to enroll eligible dependents in a voluntary insurance plan. The plan provides Anthem Blue Cross PPO medical insurance with the option to purchase Delta Dental and Vision benefits. The cost of insurance premiums for voluntary coverage is paid directly to Academic HealthPlans. Student Health Services DOES NOT manage the enrollment or collect payments for the dependent plan.

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

To enroll a dependent in the Medical, Dental and Vision Plans:

Academic HealthPlans (AHP)
ucship@ahpservice.com
(855) 871-9549
Fax: (855) 858-1964
3500 William D. Tate Ave., Suite 200
Grapevine, TX 76051

Dependent Undergrad Form UG DEPENDENT UCSB 2019-20
Dependent Graduate From GR DEPENDENT UCSB 2019-20






Graduate Students on Approved Leave of Absence (LOA)

UC Santa Barbara Graduate students who are on an "approved leave of absence" may purchase UC Student Health Insurance Plan (UC SHIP) coverage per quarter for a maximum of two quarters by contacting Academic HealthPlan (AHP) at (855) 871-9549 and enroll within 31 days of the first day of the quarter. Please note that a student that Withdrawals from UCSB is not considered on an "approved leave of absence".  In addition, the cost of insurance premiums for voluntary enrollment is paid directly to Academic HealthPlans. 

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.


To enroll in the Medical, Dental and Vision Plans:

Academic HealthPlans (AHP)
ucship@ahpservice.com
(855) 871-9549
Fax: (855) 858-1964
3500 William D. Tate Ave., Suite 200
Grapevine, TX 76051
Graduate Voluntary Form: GR VOLUNTARY 2019-20

Leave of Absence (LOA) and Dependents Enrollment Periods:

Fall Enrollment Period:        08/22/2019 - 10/23/2019
Winter Enrollment Period:
   12/06/2019 – 02/06/2020
Spring/Summer Enrollment Period:
02/28/2020 – 04/30/2020