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Medical Coverage for UC San Diego

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 and LiveHealth Online virtual visits.

Network
Out-of-Network
UC Family Providers Anthem Blue Cross Prudent Buyer PPO Network All Other Providers
  • SHC
  • UC San Diego Health System
  • Any other UC medical centers and their affiliated professional providers/facilities
Providers and facilities in the Anthem Blue Cross (PPO) Prudent Buyer 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 $500 individual/$1,000 family $1,000 individual/$2,000 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.

$2,500 individual/$5,000 family $3,350 individual/$6,700 family $7,000 individual/$14,000 family
Includes deductibles, coinsurance and medical copays. Coinsurance is the percentage of the maximum allowed amount that you are responsible for paying. Copay is the set dollar amount you are responsible for paying. 
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: 100% for primary and specialty care

UC Family

  • Primary care: 100% after $5 copay
  • Specialty care: 100% after $10 copay
  • Chiropractic Care/Acupuncture: 100% after $15 copay 
  • Primary care: 100% after $20 copay, deductible waived
  • Specialty care: 100% after $30 copay, deductible waived
60% for primary and specialty care

Professional services coinsurance

Benefit-year deductible or copays may apply. See your Benefit Booklet.

90% Mental Health/Substance Abuse: 95%
All Other: 80%
60%
Routine physicals/student adult preventive care 100% 100%, deductible waived Not covered
Mental health and substance use disorder office visits SHC: 100%
UC Family: 100% after $5 copay

100% after $10 copay, deductible waived
LiveHealth Online: 100% after $10 copay, deductible waived

60%, no copay
Inpatient hospital care Psychiatric: 95%
All Other: 90%
Mental Health/Substance Abuse: 95% after $100 copay
All Other: 80% after $500 copay
60% after $500 copay
Urgent care SHC: 100% after $20 copay
UC Family: 100% after $25 copay
100% after $50 copay, deductible waived
LiveHealth Online: 100% after $25 copay, deductible waived
60%
Emergency care (non-admission) 100% after $125 copay 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