Frequently asked questions
New IRS Reporting Requirement, to verify your ACA-compliant coverage:
1. Is UC SHIP required to report my Social Security Number (SSN) to the IRS on an annual basis?
Yes, as a self-funded health plan, UC SHIP is required by the IRS to report the name, address, SSN, and dates of coverage for all plan members, including mandatory students, voluntary students, and dependents who are covered under the Plan. Insurance Companies must also report their plan members to the IRS, so if you're covered under a fully insured private plan or your parent's plan, the insurance company will report this information to the IRS each year.
2. What if UC does not have SSNs for me or my dependent(s)?
If the university does not have your SSN, you will receive a letter from Wells Fargo Insurance Services in the next few months and asked to provide your SSN and/or that of your enrolled dependents(s). For more information, visit http://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/Individual-Shared-Responsibility-Provision.
Health plans are required by federal law to attempt several times to obtain SSNs numbers for members when their SSN is missing.
2. What is the purpose of this new IRS reporting requirement?
The purpose of annual reporting to the IRS is to verify that individuals have health care that is compliant with the Affordable Care Act law so they will not incur tax penalties. The ACA requires most Americans, including college and university students, to be covered under a qualified health care plan most of the year. Fully insured and self-funded healthcare plans must be qualified as providing Minimum Essential Coverage.
When does this new law take effect?
For 2014, citizens were asked to check a box on their tax return indicating they were covered under a qualified health plan. 2015 is the first calendar year for which your name, address, SSN, and coverage dates must be reported to the IRS. The first report is due to the IRS by March 31st, 2016 to reflect coverage for calendar year 2015.
How do I prove that I have qualified coverage?
When the IRS filing has been completed, you will receive a Form 1095-B. You can use the information on the Form on your 2015 tax return to verify that you had qualified coverage in 2015.
UC SHIP: What is it and why is it provided by the university?
To understand how UC SHIP works, it is important to understand that your health plan at UC consists of two parts:
- Student Health Services (SHS)
Each campus has a Student Health Service, a complete outpatient health center for students providing medical, behavioral health and preventive care. These facilities may be known by different names on each campus (for example, “Ashe Center” at UCLA or “Student Health Center” at Irvine, etc). SHS clinicians serve as your family doctor while you’re at school. All registered students may use services of the SHS, regardless of what type of major medical insurance they have.
- The UC Student Health Insurance Plan (UC SHIP)
As voted in by students and passed by the UC Regents, the university requires all students to have major medical insurance, and provides the UC Student Health Insurance Plan (UC SHIP) to meet this requirement. UC SHIP offers a wide range of benefits, including coverage of specialty office visits, diagnostic services, surgery, hospitalization and out-of-area care while traveling to name a few. As well, the UC SHIP package includes strong dental and vision benefits and covers most SHS fees. Students are automatically enrolled through their campus billing account, so there is no paper work. Students can choose to keep UC SHIP, or waive enrollment if they have coverage that meets the benefit standards established by the university. Most students keep UC SHIP because it is a solid, comprehensive plan. It is convenient, covers them 12 months a year anywhere in the world, offers excellent benefits, and is affordable.
How does UC SHIP work?
Many health care services students need are available at Student Health Services on campus. When you need medical care, call or visit the web site of your SHS to make an appointment. On most campuses, the SHS will file claims to UC SHIP, so you don’t have to bother with the paperwork.
If you need services at another health care facility, UC SHIP and your SHS work together to provide a comprehensive health care plan, coordinating the care you need both on and off campus. SHS clinicians will provide a referral for services outside of Student Health, and Student Health Insurance staff will transmit the referral to UC SHIP to ensure that your claims are handled accurately. Please note that with the exception of Emergency Room and Urgent Care Clinic visits, all referrals for off-campus care must be authorized by Student Health Services prior to receiving care. For services outside Student Health, UC SHIP contracts with Anthem Blue Cross to provide access to their extensive network of hospitals and providers, including UC FAMILY facilities and provider groups.
For more information about how UC SHIP works with your campus Student Health Services, or for a list of plan benefits, select your campus from the left menu bar and find the plan brochure posted on your campus home page.
Dependents of students, except UCSF spouses, are not required to use the SHS, and at some locations may not be eligible to receive services at the SHS. Please read the benefit information for dependents on your campus’ pages linked in the left menu bar.
What is the UC FAMILY network?
All in the Family--Exceptional coverage - UC medical centers and provider groups already participate in Anthem Blue Cross' Prudent Buyer network of providers that have agreed to accept Anthem's negotiated rates as full reimbursement for services. The five nationally recognized University of California health systems, including UC hospitals and affiliated professional providers have agreed to provide additional discounts for UC SHIP members. In addition, five UC SHIP campuses are introducing a 3-tiered plan design that includes no annual deductible and the lowest copayments and coinsurance in the "UC Family" tier. A student health center referral is required in order for UC SHIP to cover your health care expenses from "UC Family" and other Anthem Blue Cross network providers.
When does UC SHIP coverage begin and end?
In general, coverage periods follow the academic terms on each campus. Coverage periods may vary depending on the program in which you are enrolled. Select your campus from the left menu bar and look up the applicable enrollment form under the “Enrollment and Cost” link.
UC SHIP provides year-round health insurance coverage for continuing students. No gap in coverage during winter, spring or summer breaks.
Can I waive enrollment in UC SHIP coverage?
Yes, if you have coverage through a major medical insurance plan that meets the university's minimum criteria for health care. For waiver information, please select your campus from the left menu bar then click on Submit Online Insurance Waiver.
If I waive UC SHIP, can I still use Student Health Services on my campus?
Yes, all registered UC students can receive care at the campus Student Health Services, regardless of what type of insurance they have.
Please note, however, that fees for services vary by campus, and your SHS may not submit claims to plans other than UC SHIP.
If I am enrolled in UC SHIP can I go to any doctor I want?
Each campus Student Health Services is the primary care provider for students enrolled in UC SHIP. This means that unless you need urgent care when the SHS is closed, you should see a SHS clinician when you need medical attention or preventive care. Students are encouraged to see the same doctor or nurse practitioner for each visit, if possible. Knowing your clinician makes visits more comfortable and contributes to the most healthful outcome.
Should you need a service not offered at the SHS, your clinician will refer you to an off-campus health care provider. Your SHS clinician may suggest a specific provider, or you can choose a provider. However, we strongly recommend that UC SHIP members see providers who belong to the Anthem Blue Cross Preferred Provider Network, including UC FAMILY providers. Use of the UC FAMILY and Anthem Blue Cross network insures the least out-of-pocket costs to UC SHIP members.
Can I use my UC SHIP at other UCs?
The Student Health Services at each University of California campus gladly offers reciprocal access to currently registered students from all other UC campuses under the same conditions that apply to its own students. Please check with the SHS you plan to visit for more information about fees and filing claims to UC SHIP.
Are there deductibles with UC SHIP?
Yes, a plan year deductible applies for most medical services accessed outside Student Health. Click on your campus name in the left menu bar, and go to the Description of Benefits page to check your plan's annual deductible level. This deductible does not apply to services with fees at SHS, to emergency or urgent care clinic visits for students, or to pharmacy claims. The plan year deductible does not apply to UC FAMILY services for most UC SHIP campuses.
Is there an annual limit to my out-of- pocket payments?
Yes. Each UC SHIP campus has its own out-of-pocket limits, depending on where you access care, so check your plan brochure on your campus home page. Starting in 2014-15, students can reach their plan year out-of-pocket maximum quicker because medical and pharmacy copayments apply toward the maximum as well as coinsurance and the deductible. The lowest out-of-pocket maximum amount applies to expenses from Student Health and UC FAMILY providers. Expenses for services accessed from Anthem Blue Cross network providers is the 2nd lowest out-of-pocket maximum, and you will pay more to reach your maximum if you visit non-network providers. The out-of-pocket maximums accumulate separately for each tier. Once you have met the out-of-pocket maximum, you will not be required to pay coinsurance or medical and pharmacy copayments for covered services for the rest of that plan year. Out-of-pocket maximums do not apply to amounts exceeding stated benefit limits (for example, Accupuncture limits) or to amounts for services not covered by the plan.
What do I do if I have to go to the emergency room?
No authorization from the Student Health Services is required for visits to an emergency room or urgent care center. Please provide the facility with your Anthem Blue Cross Card. Claims provided to Anthem Blue Cross will be processed according to the UC SHIP benefits.
UC SHIP provides 100% coverage of allowed charges for emergency room services after a copayment, and 100% coverage of urgent care center allowed charges after a specified copayment. If Anthem Blue Cross determines that the reason for the visit was not an emergency, the coverage of the charges is reduced. The annual deductible does not apply to emergency room or urgent care center visits. If you are admitted to the hospital, UC SHIP covers a percentage of inpatient charges, and the emergency room copayment is waived. Please click on your campus in the left menu bar to review benefit levels, copayments and coinsurance for your campus. All follow-up care must be authorized in advance by the Student Health Services.
If I am outside of California, how do I obtain medical care?
UC SHIP provides worldwide coverage. Emergency or urgent care does not require a referral from the SHS; you should seek care from the nearest emergency room or urgent care center. Please note that referral requirements still apply for non-urgent care when you are away from campus. Please contact your SHS for information on how to obtain a referral.
While traveling in the United States, you will pay less out of pocket for care when you use a Blue Cross network provider. You can locate a Blue Cross network provider in any state on the Anthem web site UC SHIP benefits levels are the same throughout the United States.
While traveling abroad, you will likely have to use a non- network provider and pay out of pocket for care, then file a claim to UC SHIP for reimbursement. UC SHIP covers most out-of-network care at 60% of Customary and Reasonable (C&R) charges (emergency care is covered at 100% of C&R charges). Any amount above the allowed percentage of C&R charges is the plan member’s responsibility. Benefits provided abroad are coordinated by BlueCard Worldwide. For more information, select your campus from the left menu bar then look up “Coverage While Traveling” under Medical Services.
In addition to UC SHIP, the University provides a travel accident policy for students traveling on University business. The travel policy is provided at no additional cost to the students. More information on the UC travel policy.
What do I do if I receive a bill for a medical visit?
All bills for services received outside of SHS need to be directed to Anthem Blue Cross. For a claim form and information on how to submit a claim, please select your campus from the left menu bar, then look up “File or Check on a Medical Claim” under Medical Services.
How do I obtain an Anthem Blue Cross insurance card?
As a member of UC SHIP, you can expect to receive a white ID card from Anthem Blue Cross as proof of coverage. The card will be mailed to you at the local address held by your campus’ Office of the Registrar within six weeks of enrolling in UC SHIP. Please take this card with you whenever you seek medical attention outside of SHS.
Before your permanent ID card arrives, you can print a temporary card online. Also, if your permanent card does not arrive within six weeks or if you lose it, you may request a replacement permanent card.
For information on how to print a temporary card and/or request a permanent one, select your campus from the left menu bar, then look up “Temporary Anthem ID Card” under Medical Services.
Can my dependents enroll in UC SHIP?
Yes. For more information on the cost of UC SHIP for dependents, and for enrollment information, select your campus from the left menu bar and click on “Enrollment and Costs.” Please be sure to read the coverage information specific to dependents, as benefit levels for dependents vary from those for students.
Can I obtain a brochure describing UC SHIP coverage?
Please select your campus from the left menu bar then click on "Description of Benefits" for a printable brochure that provides an overview of UC SHIP coverage, or a summary of plan benefits.
Can I continue UC SHIP enrollment after I graduate?
Yes. A student who graduates may purchase UC SHIP for one additional coverage period (quarter or semester), provided the student was enrolled in UC SHIP during the coverage period in which they completed their degree.
Still have questions?
Please contact the Student Health Services on your campus. Contact information is located on your campus home page, listed in the left-hand menu bar.