When You Need Health Care
For students enrolled in UC SHIP, your health care starts at Student Health Center (SHC) as we are your primary care provider. If you need specialty medical care, special imaging modalities (e.g., MRI, CT, Ultrasound, PET) or other services not offered at SHC, you will be referred to an in-network community provider. Non-SHIP students are also eligible for all services at SHC. However, non-SHIP students must pay for services as SHC does not bill 3rd party insurance plans other than the USHIP or GSHIP plans.
Referrals to Non-SHC Providers for Medical Care
If necessary, your SHC provider will refer you for specialty care treatment, special imaging modalities or other services that are not offered at SHC. Appointments with non-SHC providers must be pre-authorized by the SHC Insurance Services Department. Care outside of SHC is coordinated by your SHC provider and the Insurance Services staff will provide referral authorizations for covered services to ensure that your claims are processed and paid accurately. SHC is the designated primary care provider (PCP) for all students enrolled in UC SHIP. Referrals to an outside PCP will not be approved unless there are extenuating circumstances (e.g., student will be away from campus and the immediate campus vicinity for an extended period of time).
The Insurance Services Department will assist you in selecting providers in the community that are in the USHIP or GSHIP preferred provider networks. If you choose to utilize providers or facilities that are not "in-network", then your claims will be paid at the "out-of-network" amount and your out-of-pocket costs will be greater. To find an Anthem Blue Cross Prudent Buyer preferred provider, you can visit Anthem’s website https://www.anthem.com/ca/ or call their customer service number at:
- (844) 437-0493 (USHIP – Undergraduate Student Plan)
- (866) 940-8306 (GSHIP – Graduate Student Plan)
or use your UC SHIP Mobile App to access Anthem’s website, your health insurance ID card, SHC and other Wellness, Health and Counseling Services websites and other useful health related information.
UC SHIP Referral Guidelines and Requirements for 2018-19
Please refer to the PDF document below for the AY 2018-19 referral guidelines and requirements that became effective 9-24-2018. The guidelines are the same for both the undergraduate and graduate plans. Please note that referrals are required for medical care rendered to a student if the student is beyond fifty (50) miles from campus. However, a visit to SHC is not required in order to obtain a referral under these circumstances. If the student is within fifty (50) miles from campus, then it is expected that the student will receive medical care at SHC. Students also require a referral for mental health services rendered outside of SHC. However, the fifty (50) mile "rule" does not apply to mental health services. In other words, if students are within fifty (50) miles from campus, there is no expectation nor a requirement that the student be seen by a mental health provider at SHC. Exceptions to the referral requirements are referenced below and in the document.
Students who are planning to be away from campus for extended periods of time (e.g., internships, fellowships, study abroad, foreign travel, etc...) should visit the Anthem website to select in-network primary care, specialty care, hospital, urgent care and other providers who are in the locality in which they'll be visiting or staying. Students are then asked to provide SHC Insurance Services department with the provider contact information (e.g., name, address, telephone and fax numbers) prior to scheduling appointments to ensure that referral authorizations are sent to the providers in advance of services being rendered. For study abroad and foreign travel for any purpose, students are strongly encouraged to contact Anthem's BlueCard PPO Program prior to travelling abroad in order to effectively plan for and/or make arrangements for medical care should it become necessary.
Exceptions to the Referral Requirements
All non-emergency services provided outside of SHC must receive a "referral authorization" from SHC subject to the AY 2018-19 referral requirements or your claim will be denied. The following medical services DO NOT require a referral authorization from Student Health Center:
- Services provided in a hospital emergency department or urgent care center for treatment of a sudden, serious or acute medical or mental health injury, illness or condition. The student must return to the SHC for necessary follow-up care.
- When services are rendered by non-SHC providers during Winter Break. Although a referral is not required, students are strongly encouraged to delay seeking medical treatment for non-urgent and non-emergency conditions until SHC reopens particularly if the student has not consulted with their SHC primary care provider.
- Pharmacy services
- Obstetrical or gynecological care
- Treatment of Mental Conditions
- Dental services
- Optometric (Vision) services
- Pediatric services
Dual Health Insurance Coverage and Coordination of Benefits
For both the undergraduate plan (USHIP) and graduate plan (GSHIP), services provided at SHC will be billed exclusively to Anthem Blue Cross regardless of whether you have dual coverage through another plan in addition to UC SHIP. Services performed at the Student Health Center are primary to any other coverage. For services that are not performed at the Student Health Center, the coverage under this Plan is secondary coverage to all other plans (including Medicare), with the exception of Medi-Cal, MRMIP, and TRICARE. If you are covered by more than one health plan, your benefits under this Plan will be coordinated with the benefits of those other plans. These coordination provisions apply separately to each Member, per Plan Year, and are largely determined by California law. Any coverage that you have for medical or pediatric dental benefits will be coordinated as indicated in the Plan Benefit Booklet.
Managing your plan
It is very important that you keep your address updated with the Office of the University Registrar as this is the same address that UC SHIP utilizes. When you move or go away for the summer, please remember to update your address with the University Registrar.