SHIP Insurance

SHIP Benefit Documents

collapse all expand all 2023-24 Berkeley SHIP Brochure SHIP Benefits Summary Wellfleet Summary of Benefits & Coverage...

1095-B / 1099 HC Forms

February 16, 2024
Wellfleet 1095-B / 1099-HC Forms

The 1095-B is an official IRS form showing a record of your health insurance coverage. The purpose of the form is to support your annual disclosure to the IRS that you are in compliance with the ACA. The 1099-HC form is required for anyone residing in the state of Massachusetts.

If you had health insurance coverage with UC Berkeley’s Student Health Insurance Plan (SHIP) through Wellfleet, you will receive the 1095-B or 1099-HC tax form in the mail.

The 1095-B and 1099-HC form is also available on...

Emergency Room, Urgent Care and Ambulance

Patient Responsibility UHS Network Provider (outside UHS) Non-Network Provider (outside UHS) Urgent Care $35 co-pay; then 10% $50 50%1, 2 Emergency Room Not available $250 (co-pay waived, if admitted) Ambulance (Ground, Air & Water Transportation) Not available 10%

1Subject to the $450 deductible (per plan year).

2If services are rendered with a non-...

Medical - Inpatient Hospital Services

Patient responsibility for inpatient hospital room & board expenses (services & supplies)

(Medical, Mental Health, & Maternity)

Network Provider

Non-network Provider

$250 co-pay; then 10%1, 2

$500 co-pay; then 50%1, 3

1Inpatient hospital services are subject to the $450 deductible (per plan year).

2For the 2023-24 plan year, beginning August 1,...

Mental Health + Substance Abuse

collapse all expand all Counseling & Psychiatry Visits Patient Responsibility UHS Network Provider (outside UHS) Non-Network Provider (outside UHS) Counseling (short term) $0 $15 50%1, 2 Psychiatry $15 $15 50%1, 2 Inpatient and Outpatient Services Patient Responsibility Network...