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