SHIP Medical Benefits

SHIP Medical Benefits: Patient Cost-sharing

Medical - Outpatient

Medical office, phone, & video visits1

UHS Network Provider (outside UHS) Non-Network Provider (outside UHS)2
Primary Care & Specialists $15 $15 50%3 

Note: If the visit is at a hospital setting, a facility (hospital) fee may apply. After the deductible, plan pays 80% for network rates or 50% non-network rates.

Adult preventative services & immunizations

UHS Network Provider (outside UHS) Non-Network Provider (outside UHS)
Adult Preventive* Services $0 $0 50%3
Preventive Immunizations** $0 $0 50%3
Other Immunizations 20% 20%3 50%3

*Services include but not limited to, physical exams, preventive screenings, (including screenings for cancer, HPV, diabetes, cholesterol, blood pressure, hearing and vision), and immunizations.

**Preventive Immunization includes Diphtheria/Tetanus/ Pertussis, Measles, Mumps and Rubella; Meningococcal; Varicella; Influenza; Hepatitis A and Hepatitis B; Pneumococcal; Polio; Human Papillomavirus; Cholera; Typhoid; Yellow Fever; Japanese B. Encephalitis; and Lyme Vaccine.

NOTE: Routine immunizations are recommended to be administered at UHS. All immunizations must meet all FDA regulations prior to approval.

Labs, tests, x-rays, & imaging

UHS  Network Provider (outside UHS) Non-Network Provider (outside UHS)2
20% 20%3
 50%3

Prenatal care, maternity, newborn, breast pump, & abortion


UHS Network Provider (outside UHS) Non-Network Provider (outside UHS)2
Prenatal care Not available $0 50%3
Breast Feeding Durable Medical Equipment Not available $0 50%3
Abortion  $0 $0 0%4

Midwives: To locate in-network midwives, visit the Aetna website and log into your member account or search as a guest in the "Open Choice PPO" network under "Student Health Medical Plans in California".

Newborns5 are covered for the first 31 days from date of birth unless the student’s coverage ends before then. Coverage after the first 31 days of life is offered through the dependent plan. To enroll a newborn, call the SHIP office within 31 days of the baby’s birth.

Acupuncture & Chiropractic Care


Network Provider (outside UHS) Non-Network Provider (outside UHS)2
$25 50%

Physical Therapy, Occupational Therapy, & Speech Therapy

UHS Network Provider (outside UHS) Non-network Provider (UHS)2
Physical Therapy $15: then 20% $15; then 20%3 50%3
Occupational Therapy & Speech Therapy Not available $15; then 20%3 50%3

Allergy Testing & Injections

Network Provider (outside UHS) Non-Network Provider (outside UHS)2
20%3 50%3

Home Health Visits & Skilled Nursing Facility 

Network Provider (outside UHS) Non-Network Provider (outside UHS)2
20%3 50%3

Note: Home Health Care and Skilled Nursing Facility benefits are limited to 100 visits per policy year.

Durable Medical Equipment1

UHS Network Provider (outside UHS) Non-Network Provider (outside UHS)2
20% 20%3 50%3

For rental or purchase of medical equipment and supplies ordered by a physician and are of no further use when medical need ends. For breast pump coverage, please see maternity benefits. 

Equipment must be obtained from a durable medical equipment supplier, including rental or purchase of diabetic equipment and supplies (excluding insulin). 

Fertility Preservation 

See the fertility preservation flyer for benefit details. 

Medical - Inpatient Hospital Services

  • Network Provider: $250 co-pay; then 20%1, 3
  • Non-network Provider: $500 co-pay; then 50%2, 3

Note: Inpatient hospital care in connection with childbirth will be covered for at least 48 hours following a normal delivery (96 hours following a cesarean section). 

Emergency Room, Urgent Care, and Ambulance

UHS Network Provider (outside UHS) Non-Network Provider (outside UHS)
Urgent Care $35 co-pay; then 20% $50 $506
Emergency Room Not available $250 (co-pay waived, if admitted)
Ambulance (Ground, Air & Water Transportation) Not available $0

Advice Nurse

  • UHS Advice Nurse: Students can speak with the UHS Advice Nurse by calling (510) 643-7197. 

Urgent Care + Emergency Room Locations

All listed centers are in-network providers, meaning SHIP will reimburse a portion of fees incurred after the co-pay.

Mental Health and Substance Abuse

Counseling & Psychiatry Visits 

Patient Responsibility  UHS Network Provider (outside UHS) Non-Network Provider (outside UHS)
Counseling (short term) $0 $15 50%2, 3 
Psychiatry $15 $15 50%2, 3
Inpatient and Outpatient Services
Patient Responsibility  Network Provider (outside UHS) Non-Network Provider (outside UHS)
Inpatient & Residential Treatment Centers 20%3 50%2, 3
Intensive Outpatient Program & Partial Hospitalization 20%3 50%2, 3
Psychoeducational Testing 20%3 50%2, 3

1No cost-sharing for covered medical expenses incurred for the treatment of hypertension, diabetes, and pre-cervical cancer with UHS and in-network providers.

2If services are rendered with a non-network provider, SHIP covers 50% of the usual and customary charge after the deductible is met. Members are responsible for all costs over the usual and customary charge.

3Subject to the $450 deductible (once per plan year).

4If services are rendered with a non-network provider, SHIP covers 100% of the usual and customary charge. Members are responsible for all costs over the usual and customary charge. 

5If the student's plan terminates before the 31 days from the date of birth, the newborn's coverage ends on the same termination date as that of the student.

6If services are rendered with a non-network provider, SHIP covers 100% of the usual and customary charge after a co-pay of $50. All costs over the usual and customary charge is the member’s responsibility.

Note: This page provides a summary of some benefits. Please see the Aetna Plan Design and Benefits Summary for plan details

Topics

SHIP Insurance topic page