Medical

What You Need to Know

If you are covered by UC SHIP, you will need a referral from the Student Health Services (SHS) 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 SHS will provide a referral for services it can’t provide.

What You Pay for Care

    You’ll pay nothing for preventive care at the SHS, and low copays for other services and procedures.

    Except for preventive care, you will pay a deductible for services you receive outside the SHS 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 San Diego Benefit Booklet [PDF].

     

    You Need a Referral for Care Outside the SHS

    If you are covered by UC SHIP, you need a referral from the SHS 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.

    Inside the SHS

    Benefit-Year Deductible
    You Pay
    $0
    Limits on Your Out-of-Pocket Costs (combined with UC Family costs)
    You Pay
    Individual: $2,000
    Family: $3,000
    Office Visits (primary and specialty care)
    You Pay
    $01
    Routine Physicals/Adult Student Preventive Care
    You Pay
    $0
    Office Visits (mental health and substance use disorders)
    You Pay
    $0
    Urgent Care
    You Pay
    $0
    Emergency Care (non-admission)
    You Pay
    N/A
    Inpatient Hospital Care
    You Pay
    N/A
    Lab Tests (e.g., bloodwork)
    You Pay
    $0
    X-rays
    You Pay
    $0
    Pediatric Dental and Vision Care (up to age 19)
    You Pay
    N/A
    1. Additional charges for other services, such as lab work. For details, review the UC San Diego Benefit Booklet [PDF].

    For more information about SHS services, visit the Student Health Services website.

    UC Family Providers

    UC Family providers include the SHS, the UC San Diego Health System, and any other UC medical centers and their affiliated facilities and professional providers. Refer to the SHS chart above for specific SHS charges.

    You Pay
    Benefit-Year Deductible
    $0
    Limits on Your Out-of-Pocket Costs (combined with SHC)
    Individual: $2,000
    Family: $3,000
    Office Visits (primary care)
    $5 copay1
    Office Visits (specialty care)
    $10 copay1
    Office Visits (chiropractic/acupuncture)
    $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 (non-admission)
    $125 copay
    Inpatient Hospital Care
    Psychiatric: 5% coinsurance
    All other: 10% coinsurance
    Lab Tests (e.g., bloodwork)
    10% coinsurance
    X-rays
    10% coinsurance
    Pediatric Dental and Vision Care (up to age 19)
    N/A
    1. Additional charges for other services, such as lab work. For details, review the UC San Diego Benefit Booklet [PDF].
    Anthem Blue Cross Prudent Buyer PPO Network Providers

    Network providers are those in the Anthem Blue Cross Prudent Buyer PPO network, including UC Family medical centers, affiliated facilities, and professional providers.

    You Pay
    Benefit-Year Deductible
    Individual: $500
    Family: $1,000
    Limits on Your Out-of-Pocket Costs
    Individual: $2,500
    Family: $3,500
    Office Visits (primary care)
    $20 copay,1 deductible waived
    Office Visits (specialty care)
    $30 copay,1 deductible waived
    Routine Physicals/Adult Student Preventive Care
    $0, deductible waived
    Office Visits (mental health and substance use disorders)
    $10 copay, deductible waived
    LiveHealth Online
    Mental health and substance abuse disorders: $10 copay, deductible waived
    Medical, including urgent care: $25 copay, deductible waived
    Urgent Care
    $50 copay, deductible waived
    Emergency Care
    $125 copay, deductible waived
    Inpatient Hospital Care (mental health and substance use disorders)
    5% coinsurance after $500 copay
    Inpatient Hospital Care (all other)
    20% coinsurance after $500 copay2
    Lab Tests (e.g., bloodwork)
    20% coinsurance
    X-rays
    20% coinsurance
    Pediatric Dental Checkup (up to age 19)
    $0
    Pediatric Basic and Major Dental Services (up to age 19)
    50% coinsurance
    Pediatric Vision Exam, Frame (formulary), Standard Lenses/Contact Lenses (up to age 19)
    $0

    1. Additional charges for other services, such as lab work. For details, review the UC San Diego 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 San Diego 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.

    You Pay
    Benefit-Year Deductible
    Individual: $1,000
    Family: $2,000
    Limits on Your Out-of-Pocket Costs
    Individual: $5,000
    Family: $7,000
    Office Visits (primary and specialty care)
    40% coinsurance
    Professional Services1
    40% coinsurance2
    Routine Physicals/Adult Student Preventive Care
    Not covered
    Office Visits (mental health and substance use disorders)
    40% coinsurance
    Inpatient Hospital Care
    40% coinsurance after $500 copay
    Urgent Care
    40% coinsurance
    Emergency Care (non-admission)
    $125 copay, deductible waived
    Lab Tests (e.g., bloodwork)
    40% coinsurance
    X-rays
    40% coinsurance
    Pediatric Dental Checkup (up to age 19)
    $0
    Pediatric Basic and Major Dental Services (up to age 19)
    50% coinsurance
    Pediatric Vision Exam, Frame (formulary), Standard Lenses/Contact Lenses (up to age 19)
    100% after $30 exam allowance, $45 frame allowance, and $25 lens allowance
    1. Includes intensive medical care required by your condition, surgery, general anesthesia, newborn exams, diagnostic test interpretation.
    2. Benefit-year deductible or copays may apply. See the UC San Diego Benefit Booklet [PDF].

    We Cover Your Transition

    UC SHIP covers gender-affirming care.

    Finding Care Outside the SHS

    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 SHS. 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 Services (SHS)

    Your first stop for care on campus
    Main number/appointments: (858) 534-8089
    Counseling and Psychological Services (CAPS): (858) 534-3755
    SHS website
    Library Walk, west of the Price Center, south of Geisel Library