How to use SHIP

When you need health care

With SHIP, all care must begin at University Health Services (UHS) (also known as the Tang Center). When you need medical care, simply call to make an appointment. SHIP members pay $15 for a primary care office visit and $35 for an Urgent Care clinic visit at the Tang Center ($50 co-pay for off-campus Urgent Care centers in Anthem network). For most other services, SHIP members pay 10% of UHS fees. There are no claims to file for UHS visits, and you will not have to pay any deductibles for any services at the Tang Center. Your primary care physician will provide you with a referral for any additional services that are not available at the Tang Center.

Don't get stuck with the bill! An authorized referral by a UHS Clinician is required prior to seeking services outside of Tang or your claims will be denied or penalized. Qualified emergency room care, urgent care, prescriptions, international services and limited preventive and women's health services are the only exceptions.

Referrals from UHS clinicians

When you need health care outside of the area

All services outside the Tang Center require a referral from the SHIP office, except for emergency room or urgent care services, prescriptions, international services, and limited preventive and women's health services. 

If you are out of the area and require care that is of medical necessity, please contact the Student Health Insurance Office at (510) 642-5700 for authorization. An authorized referral will be provided to you for an office visit to an outside primary care physician. SHIP is a nationwide plan and there are Anthem providers across the country. You can visit the Anthem Blue Cross website to locate network providers. Your primary care physican will have to complete the referral authorization request form for any additional services or to refer you to another specialist. 

If you are out of the country, for more information on using SHIP abroad, please see this guideOn Call International is the 24/7 Emergency Travel Assistance Services benefit for SHIP members. Please contact On Call International before you travel. For calls within U.S., dial (877) 318-6901. For calls outside the U.S., call collect by dialing the U.S. access code plus (603) 328-1909. 

Emergency care

Emergency room and urgent care services do not require a referral. Please provide the facility with your Anthem Blue Cross ID card. Claims submitted to Anthem Blue Cross will be processed according to the SHIP benefits. All follow-up care must be authorized in advance by the Student Health Insurance Office. Please visit the Tang Center primary care, urgent care or contact the advise nurse at 510-642-7197 to submit the referral request.

Pre-existing conditions

In compliance with the Affordable Care Act requirement, SHIP does not exclude pre-existing conditions. There is no waiting period for coverage for pre-existing conditions.

Referral for services

Most non-emergency services provided outside of UHS must receive prior authorization or your claim may not be paid. Services outside UHS that do not require pre-authorization include: Services provided in a hospital emergency room or urgent care clinic, prescriptions, international services, and limited preventative and women's health visits. For all other non-emergency medical care outside UHS, see SHIP Referrals for more details.

Billing for services at UHS

UHS will bill Anthem Blue Cross directly for services provided at the Tang Center. At the time of service, patients will pay their co-pays. Some services will require students pay 10% of the total service cost. This is not charged on the date of service but will be later billed to the student. Students can return to UHS within 21 days to pay their 10% charges or have the charges billed to their Cal Central account. The remainder of the charges will be billed to Anthem Blue Cross.

Billing for services outside UHS

When students receive care outside of the Tang Center, the health care provider may require payment of the student's portion of fees at the time of service, or they may send a bill after SHIP has paid the covered amount. Most providers will submit bills directly to Anthem Blue Cross. If you receive a medical bill and the provider has not billed Anthem Blue Cross for services, please call the number on the bill and give them your Anthem Blue Cross ID number and ask them to re-bill the claim directly to Anthem Blue Cross. If you choose to visit a non-network provider, you will have 365 days to submit a claim to Anthem Blue Cross for reimbursement.

For out of country claims: You will be required to pay up front for the services and submit for reimbursement upon return. You have 365 days from the date of service to do so. 

Deductibles

There is a $300 plan year deductible for some services provided outside UHS. SHIP members are responsible for the first $300 of qualified charges outside of UHS each plan year. Once the deductible has been satisfied, SHIP benefits begin. Medical and mental health office visits, emergency room visits, urgent care center visits and prescriptions are not subject to the annual deductible.

Dual coverage

Services provided at UHS will be billed exclusively to SHIP regardless if you have dual coverage through another plan in addition to SHIP.

For services provided outside of UHS, standard coordination of benefit practices apply. An authorization from the Tang Center will still be required in order to receive coverage through Anthem Blue Cross. Please contact Anthem Blue Cross at (844) 728-5913 for coordination of benefit questions.

Important reminder: If you have Medi-Cal or Tricare, SHIP is always primary.

Annual out-of-pocket maximum

Students are responsible for no more than $3,200 of in-network out-of-pocket expenses each plan year. If you have paid $3,200 in co-insurance and deductibles to in-network providers, you will no longer be required to pay co-insurance for services obtained from in-network providers for the remainder of the plan year. The in-network out-of-pocket maximum does not apply to non-network providers or to services not covered by the plan.

The non-network out-of-pocket maximum for services and providers is $6,500.

Lifetime maximum

There is no lifetime maximum on the plan.

Managing your plan - update your address

Updated address: It is very important that you keep your address updated within Cal Central. This is how Anthem Blue Cross knows your address. When you move or go away for the summer, please remember to update your address.

SHIP Patient Rights  + Responsibilities 

Glossary of Insurance Terms