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Plan Documents

For your reference, following are the documents that guide the administration of your UC SHIP plans. 

Plan Year 2017-2018

Plan Year 2016-2017

Campus 2017-2018 Documents
Davis Student Medical Summary of Benefits & Coverage (SBC)
Anthem Benefit Booklet
Anthem Benefit Booklet (Spanish Version)
Anthem Benefit Booklet (Mandarin Version)
Delta Dental Evidence of Coverage
Delta Dental Evidence of Coverage (Spanish version)
OptumRx Pharmacy Plan Booklet
Vision Plan Booklet
Vision Plan Booklet (Spanish version)
Hastings Student Medical Summary of Benefits & Coverage (SBC)
Anthem Benefit Booklet
Anthem Benefit Booklet (Spanish Version)
Anthem Benefit Booklet (Mandarin Version)
Delta Dental Evidence of Coverage
Delta Dental Evidence of Coverage (Spanish version)
OptumRx Pharmacy Plan Booklet
Vision Plan Booklet
Vision Plan Booklet (Spanish version)
Irvine Student Medical Summary of Benefits & Coverage (SBC)
Anthem Benefit Booklet
Anthem Benefit Booklet (Spanish Version)
Anthem Benefit Booklet (Mandarin Version)
Delta Dental Evidence of Coverage
Delta Dental Evidence of Coverage (Spanish version)
OptumRx Pharmacy Plan Booklet/a>
Vision Plan Booklet
Vision Plan Booklet (Spanish version)
Los Angeles Student Medical Summary of Benefits & Coverage (SBC)
Anthem Benefit Booklet
Anthem Benefit Booklet (Spanish Version)
Anthem Benefit Booklet (Mandarin Version)
Delta Dental Evidence of Coverage
Delta Dental Evidence of Coverage (Spanish version)
OptumRx Pharmacy Plan Booklet
Vision Plan Booklet
Vision Plan Booklet (Spanish version)
Merced Student Medical Summary of Benefits & Coverage (SBC)
Anthem Benefit Booklet
Anthem Benefit Booklet (Spanish Version)
Anthem Benefit Booklet (Mandarin Version)
Delta Dental Evidence of Coverage
Delta Dental Evidence of Coverage (Spanish version)
OptumRx Pharmacy Plan Booklet
Vision Plan Booklet
Vision Plan Booklet (Spanish version)
Riverside Student Medical Summary of Benefits & Coverage (SBC)
Anthem Benefit Booklet
Anthem Benefit Booklet (Spanish Version)
Anthem Benefit Booklet (Mandarin Version)
Delta Dental Evidence of Coverage
Delta Dental Evidence of Coverage (Spanish version)
OptumRx Pharmacy Plan Booklet
Vision Plan Booklet
Vision Plan Booklet (Spanish version)
San Diego Student Medical Summary of Benefits & Coverage (SBC)
Anthem Benefit Booklet
Anthem Benefit Booklet (Spanish Version)
Anthem Benefit Booklet (Mandarin Version)
Delta Dental Evidence of Coverage
Delta Dental Evidence of Coverage (Spanish version)
OptumRx Pharmacy Plan Booklet
Vision Plan Booklet
Vision Plan Booklet (Spanish version)
San Francisco Student Medical Summary of Benefits & Coverage (SBC)
Anthem Benefit Booklet
Anthem Benefit Booklet (Spanish Version)
Anthem Benefit Booklet (Mandarin Version)
Delta Dental Evidence of Coverage
Delta Dental Evidence of Coverage (Spanish version)
OptumRx Pharmacy Plan Booklet
Vision Plan Booklet
Vision Plan Booklet (Spanish version)
Santa Cruz Student Medical Summary of Benefits & Coverage (SBC)
Anthem Benefit Booklet
Anthem Benefit Booklet (Spanish Version)
Anthem Benefit Booklet (Mandarin Version)
Delta Dental Evidence of Coverage
Delta Dental Evidence of Coverage (Spanish version)
OptumRx Pharmacy Plan Booklet
Vision Plan Booklet
Vision Plan Booklet (Spanish version)
Campus 2016-2017 Documents
Davis MEC (Minimum Essential Coverage) Notice to Students
Anthem Benefit Booklet
Student Medical Summary of Benefits & Coverage (SBC)
Student Medical Summary of Benefits & Coverage (SBC) (Spanish version)
Student Medical Summary of Benefits & Coverage (SBC) (Mandarin version)
OptumRx Pharmacy Plan Booklet
OptumRx Pharmacy Formulary
OptumRx Pharmacy Formulary Exclusions
Dental Plan Booklet
Vision Plan Booklet
Hastings MEC (Minimum Essential Coverage) Notice to Students
Anthem Benefit Booklet
Student Medical Summary of Benefits & Coverage (SBC)
Student Medical Summary of Benefits & Coverage (SBC) (Spanish version)
Student Medical Summary of Benefits & Coverage (SBC) (Mandarin version)
OptumRx Pharmacy Plan Booklet
OptumRx Pharmacy Formulary
OptumRx Pharmacy Formulary Exclusions
Dental Plan Booklet
Vision Plan Booklet
Irvine MEC (Minimum Essential Coverage) Notice to Students
Anthem Benefit Booklet
Student Medical Summary of Benefits & Coverage (SBC)
Student Medical Summary of Benefits & Coverage (SBC) (Spanish version)
Student Medical Summary of Benefits & Coverage (SBC) (Mandarin version)
OptumRx Pharmacy Plan Booklet
OptumRx Pharmacy Formulary
OptumRx Pharmacy Formulary Exclusions
Dental Plan Booklet
Vision Plan Booklet
Los Angeles MEC (Minimum Essential Coverage) Notice to Students
Anthem Benefit Booklet
Student Medical Summary of Benefits and Coverage (SBC)
Student Medical Summary of Benefits & Coverage (SBC) (Spanish version)
Student Medical Summary of Benefits & Coverage (SBC) (Mandarin version)
OptumRx Pharmacy Plan Booklet
OptumRx Pharmacy Formulary
OptumRx Pharmacy Formulary Exclusions
Dental Plan Booklet
Vision Plan Booklet
Merced MEC (Minimum Essential Coverage) Notice to Students
Anthem Benefit Booklet
Student Medical Summary of Benefits & Coverage (SBC)
Student Medical Summary of Benefits & Coverage (SBC) (Spanish version)
Student Medical Summary of Benefits & Coverage (SBC) (Mandarin version)
OptumRx Pharmacy Plan Booklet
OptumRx Pharmacy Formulary
OptumRx Pharmacy Formulary Exclusions
Dental Plan Booklet
Vision Plan Booklet
Riverside MEC (Minimum Essential Coverage) Notice to Students
Anthem Benefit Booklet
Student Medical Summary of Benefits & Coverage (SBC)
Student Medical Summary of Benefits & Coverage (SBC) (Spanish version)
Student Medical Summary of Benefits & Coverage (SBC) (Mandarin version)
OptumRx Pharmacy Plan Booklet
OptumRx Pharmacy Formulary
OptumRx Pharmacy Formulary Exclusions
Dental Plan Booklet
Vision Plan Booklet
San Diego MEC (Minimum Essential Coverage) Notice to Students
Anthem Benefit Booklet
Student Medical Summary of Benefits & Coverage (SBC)
Student Medical Summary of Benefits & Coverage (SBC) (Spanish version)
Student Medical Summary of Benefits & Coverage (SBC) (Mandarin version)
OptumRx Pharmacy Plan Booklet
OptumRx Pharmacy Formulary
OptumRx Pharmacy Formulary Exclusions
Dental Plan Booklet
Vision Plan Booklet
San Francisco MEC (Minimum Essential Coverage) Notice to Students
Anthem Benefit Booklet
Student Medical Summary of Benefits & Coverage (SBC)
Student Medical Summary of Benefits & Coverage (SBC) (Spanish version)
Student Medical Summary of Benefits & Coverage (SBC) (Mandarin version)
OptumRx Pharmacy Plan Booklet
OptumRx Pharmacy Formulary
OptumRx Pharmacy Formulary Exclusions
Dental Plan Booklet
Vision Plan Booklet
Santa Cruz MEC (Minimum Essential Coverage) Notice to Students
Anthem Benefit Booklet
Student Medical Summary of Benefits & Coverage (SBC)
Student Medical Summary of Benefits & Coverage (SBC) (Spanish version)
Student Medical Summary of Benefits & Coverage (SBC) (Mandarin version)
OptumRx Pharmacy Plan Booklet
OptumRx Pharmacy Formulary
OptumRx Pharmacy Formulary Exclusions
Dental Plan Booklet
Vision Plan Booklet