Skip to content

Medical Coverage for UC Irvine

ALL CARE MUST START WITH THE SHC TO BE COVERED BY UC SHIP

You must get an SHC referral for care outside the SHC, regardless of the distance from campus, except for the following: emergency room care and visits to urgent care clinics, pediatric care, obstetrics services, gynecological care, vision care, dental care and pharmacy services.

During winter break when the SHC is closed, you can visit an Anthem Blue Cross clinician without a referral. However, be sure to get a referral from your primary care clinician in the Anthem Blue Cross Prudent Buyer PPO network if you need to see a specialist.

Network
Out-of-Network
UC Family Providers Anthem Blue Cross PPO Providers All Other Providers
  • SHC
  • UC Irvine Health, affiliated facilities and providers including UC Irvine Medical Center
Providers and facilities in the Anthem Blue Cross Prudent Buyer PPO network Any health care provider/facility you choose; however you are responsible for paying any expenses above the Anthem Blue Cross maximum allowed amount.
Separate benefit-year deductibles

The amount you pay before UC SHIP pays for services.

$0 $300/individual; $600/family $500/individual; $1,000/family
Separate annual limits on your out-of-pocket costs

If your medical and/or pharmacy expenses reach this amount, UC SHIP will pay 100% of your covered expenses for the rest of the plan year.

$2,000/individual; $4,000/family $3,000/individual; $6,000/family $6,000/individual; $12,000/family
Includes deductibles, coinsurance, medical copays and prescription copays
UC SHIP Covers

Office visits

Copay covers office visit only. Additional charges apply for other services, such as lab work. For details, see the Medical Summary of Benefits and Coverage (SBC).

SHC
  • Primary care: 100% after $5 copay
  • Specialty care: 100% after $15 copay
UC Family
  • Primary care: 100% after $5 copay
  • Specialty care: 100% after $15 copay
  • 100% after $10 copay, deductible waived
  • Specialty care: 100% after $25 copay, deductible waived
60% for primary and specialty care
Routine physicals/student adult preventive care 100% 100%, deductible waived Not covered
Mental health and substance use disorder office visits 100% after $5 copay, deductible waived 100% after $10 copay, deductible waived
LiveHealth Online: 100% after $10 copay, deductible waived
60%, no copay
Inpatient hospital care 95% 90% after $500 copay 60% after $500 copay
Urgent care 100% after $25 copay 100% after $25 copay, deductible waived
LiveHealth Online: 100% after $10 copay, deductible waived
60%
Emergency care (non-admission) 100% after $125 copay (waived if admitted) 100% after $125 copay, deductible waived

100% after $125 copay, deductible waived

Pediatric dental and vision care

Up to age 19

N/A

Dental checkup: 100%; basic and major services 50%

Vision exam, frame (formulary) and standard lenses, and contact lenses: 100%

Dental checkup: 100%; basic and major services 50%

Vision: Up to $30 allowance for exam, $45 for frame and $25 for lenses