Medical

What You Need to Know

If you are covered by UC SHIP, you will need a referral from the Student Health Center (SHC) to get care anywhere else — except for emergency room care, urgent care clinic visits, pediatric care, obstetrics services, gynecological care, Lyra Health, and LiveHealth Online virtual visits.

If needed, the SHC will provide a referral for services it can’t provide.

If you need care during break when the SHC is closed, you can visit an Anthem Blue Cross primary care doctor without a referral. But if you need to see a specialist, your visit will be covered only if you get a referral from a primary care doctor in the Anthem Blue Cross Prudent Buyer PPO network.

What You Pay for Care

    You’ll pay nothing for preventive care at the SHC, and low copays for other services and procedures. If needed, the SHC will provide a referral for services it can’t provide.

    Except for preventive care, you will pay a deductible for services you receive outside the SHC or the UC network of doctors and facilities, unless otherwise noted. After you meet the deductible, the plan will pay a portion of the cost. If you receive any care from an out-of-network provider, you will be responsible for your coinsurance plus any amount above the maximum allowable charges.

    You’ll always pay more when you receive care from providers who are not part of the UC SHIP or Anthem Blue Cross Prudent Buyer PPO networks.

    Based on where you receive care, here’s what you can expect to pay for typical health care services.

    Note: Office visit copays do not include what you’ll pay for other services, such as lab work and X-rays. For coverage details, including expenses and services the plan does not cover, see the UC Irvine Benefit Booklet [PDF].

    You Need a Referral for Care Outside the SHC

    If you are covered by UC SHIP, you need a referral from the SHC to get care anywhere else — except for emergency room care, urgent care clinic visits, pediatric care, obstetrics services, gynecological care, Lyra Health, and LiveHealth Online virtual visits, and care needed during breaks when SHCS is closed.

    Inside the SHC

    You Pay
    Benefit-Year Deductible
    $0
    Limits on Your Out-of-Pocket Costs (combined with UC Family costs)
    Individual: $2,000
    Family: $4,000
    Office Visits (primary care
    $5 copay1
    Office Visits (specialty care)
    $15 copay1
    Routine Physicals/Adult Student Preventive Care
    $0
    Office Visits (mental health and substance use disorders)
    $5 copay
    Urgent Care
    $25 copay
    Emergency Care
    $125; copay waived if you are admitted
    Inpatient Hospital Care
    5% coinsurance
    Lab Tests (e.g., bloodwork)
    N/A
    X-rays
    N/A
    Pediatric Dental and Vision Care (up to age 19)
    N/A
    1. You’ll pay additional charges for other services, such as lab work. For details, review the UC Irvine Benefit Booklet [PDF].

    For more information about SHC services, visit the Student Health Center website.

    UC Family Providers

    UC Family providers include the SHC; UC Irvine Health, affiliated facilities and providers, including UC Irvine Medical Center and any other UC medical centers and their affiliated facilities and professional providers. Refer to the SHC chart above for specific SHC charges.

    Benefit-Year Deductible
    Limits on Your Out-of-Pocket Costs (combined with SHC)
    Office Visits (primary care)
    Office Visits (specialty care)
    Routine Physicals/Adult Student Preventive Care
    Office Visits (mental health and substance use disorders)
    Urgent Care
    Emergency Care
    Inpatient Hospital Care
    Lab Tests (e.g., bloodwork)
    X-rays
    Pediatric Dental and Vision Care (up to age 19)
    You Pay
    $0
    Individual: $2,000
    Family: $4,000
    $5 copay1
    $15 copay1
    $0
    $5 copay
    $25 copay
    $125 copay
    5% coinsurance, deductible waived
    5% coinsurance, deductible waived
    5% coinsurance
    N/A
    1. You’ll pay additional charges for other services, such as lab work. For details, review the UC Irvine Benefit Booklet [PDF].

     

    Anthem Blue Cross Providers
    Benefit-Year Deductible
    Limits on Your Out-of-Pocket Costs
    Office Visits (primary care)
    Office Visits (specialty care)
    Routine Physicals/Adult Student Preventive Care
    Office Visits (mental health and substance use disorders)
    LiveHealth Online (medical care, mental health and substance use disorders)
    Urgent Care
    Emergency Care (non-admission)
    Inpatient Hospital Care
    Lab Tests (e.g., bloodwork)
    X-rays
    Pediatric Dental Checkup (up to age 19)
    Pediatric Basic and Major Dental Services (up to age 19)
    Pediatric Vision Exam, Frame (formulary), Standard Lenses/Contact Lenses (up to age 19)
    You Pay
    Individual: $300
    Family: $600
    Individual: $3,000
    Family: $6,000
    $10 copay,1 deductible waived
    $25 copay,1 deductible waived
    $0, deductible waived
    $0, deductible waived
    $0, deductible waived
    $25 copay, deductible waived
    $125 copay, deductible waived
    10% coinsurance after $500 copay2
    10% coinsurance
    10% coinsurance
    $0
    50% coinsurance
    $0
    1. You’ll pay additional charges for other services, such as lab work. For details, review the UC Irvine Benefit Booklet [PDF].
    2. An additional 25% penalty is assessed for services and supplies provided by an out-of-network hospital. For details, review the UC Irvine Benefit Booklet [PDF].
    Out-of-Network Providers

    As a reminder, you must first meet your annual deductible before the plan begins to share costs with you.

    Benefit-Year Deductible
    Limits on Your Out-of-Pocket Costs
    Office Visits (primary and specialty care)
    Routine Physicals/Adult Student Preventive Care
    Office Visits (mental health and substance use disorders)
    Urgent Care
    Emergency Care
    Inpatient Hospital Care
    Lab Tests (e.g., bloodwork)
    X-rays
    Pediatric Dental Checkup (up to age 19)
    Pediatric Basic and Major Dental Services (up to age 19)
    Pediatric Vision Exam, Frame (formulary), Standard Lenses/Contact Lenses (up to age 19)
    You Pay
    Individual: $500
    Family: $1,000
    Individual: $6,000
    Family: $12,000
    40% coinsurance
    Not covered
    40% coinsurance
    40% coinsurance
    $125 copay, deductible waived
    40% coinsurance after $500 copay
    40% coinsurance
    40% coinsurance
    $0
    50% coinsurance
    100% after $30 exam allowance, $45 frame allowance, and $25 lens allowance

    We Cover Your Transition

    UC SHIP covers gender-affirming care.

    Finding Care Outside the SHC

    To find an Anthem network provider, visit the Anthem website and follow the steps below:

    1. Select Find Care at the top of the page.
    2. Select Guests unless you’re already registered with Anthem.
    3. Scroll down to What type of care are you searching for? and select Medical.
    4. Scroll down to What state do you want to search with? and select California.
    5. Scroll down to What type of plan do you want to search with? and select Medical (Student Health).
    6. Scroll down to Select a plan/network. In the drop-down menu, choose UCSHIP, and then click Continue.
    7. On the following page, insert your city (e.g., Riverside, CA).
    8. Scroll down to Search by Care Provider.
    9. To find a Primary Care doctor, select Primary Care.
    10. This will generate a list of Physicians & Medical Professionals. Select from those tagged Family Practice or Internal Medicine. These are the providers you can visit after you have received a referral from the SHC. You will need to contact the provider to confirm whether they are taking new patients.

    Contacts

    Anthem Blue Cross Network

    Member Services
    (866) 940-8306

    Student Health Center (SHC)

    Your first stop for care on campus
    Main number: (949) 824-5301
    Medical and psychiatry appointments: (949) 824-5304
    Dental clinic appointments: (949) 824-5307
    Insurance services: (949) 824-2388
    SHC website

    SHC
    501 Student Health, corner of East Peltason and Pereira drives
    (Bldg. 5 on the campus map)

    Dental Clinic
    Across the street from the main SHC, also at the corner of East Peltason and Pereira drives
    (Bldg. 6 on the campus map)