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Payment of Your Copays, Coinsurance and Deductibles

For students covered by UC SHIP

Following your visits, SHC will submit a claim to the UC SHIP insurance carrier for the services that you received at SHC. Once payment is received from the carrier (typically 2-3 weeks following the date of service), the portion for which you are responsible (e.g., co-pay, coinsurance, deductible) will be transferred to your campus billing or “Zot” account for payment. See ZOT Account Online to logon to your account; make payments and for other information regarding the Student Billing System.

For students with health insurance other than SHIP

SHC does not bill any health insurance plan other than the UC SHIP plans. SHC will transfer the charges for any services that you received and for which you are responsible to your campus billing account. You may submit a claim to your insurance carrier to seek reimbursement of these expenses and include an itemized statement of charges from SHC which you can view/print via the Student Health Patient Portal.

Billing for services outside SHC

When students receive care outside of Student Health Center, the health care provider may require you to pay the co-payment and/or coinsurance at the time of service, or they may send you a bill after the insurance company has paid the covered amount. Most providers will submit bills directly to the insurance company. If a student receives a bill for the full cost of services, the student should contact Anthem Blue Cross for assistance.

Preventive Care Services - No Copayment or Coinsurance Payment Required (UC SHIP Enrolled Students)

If you are enrolled in UC SHIP, there are many preventive care services for which you have no copayment and/or no coinsurance payment responsibility. Please refer to the document below for a current list of services that are considered preventive care and, therefore, are not subject to a copayment and/or coinsurance payment. 

PDF iconPreventive Care Services at SHC – No Copay or Coinsurance Payment Required

If you are NOT enrolled in UC SHIP, then you are responsible for payment of the entire fee related to any service rendered at SHC. However, you may seek reimbursement from your health insurance carrier. Please note that managed care/HMO insurance plans (e.g., Kaiser, Medi-Cal/Cal-Optima, Sutter Health, Blue Shield HMO, other HMO's) will likely NOT reimburse you for non-urgent, routine and/or preventive care services.

For questions about claims or the Explanation of Benefits

Anthem Member Services: 866-940-8306
 

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 that 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. You can print and use an "international claim form" from Anthem BlueCard Worldwide. To ensure proper payment or reimbursement of your claim, make sure that you receive 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 insurance number.
  • Dates of service.
  • Procedure codes for service 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.

Deductibles

(Note: For Academic/Plan Year 2019-20, UC SHIP benefits, copays, deductibles, coinsurance % and out-of-pocket maximums are the same for both undergraduate and graduate students.)

  • No deductible applies to services rendered at Student Health Center or at any UC/UCI Health affiliated provider.
  • There is a $300 in-network plan year deductible ($600/family) and a $500 out-of-network plan year deductible ($1,000/family) for most services provided outside SHC. Network and out-of-network deductibles are not combined. If a deductible applies, UC SHIP benefits begin once the deductible has been satisfied. Amounts over the "limited fee schedule" as determined by UC SHIP do not accumulate toward the deductible. 

See Eligibility and Payment for Services for additional information and SHC fees for the most common services.