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Below you will find useful information about the

University of California – Irvine
Undergraduate Student Health Insurance Plan (USHIP)

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Early Start Enrollment

Students enrolled in a 2016-2017 Early Start Program and who wish to voluntarily enroll in the Student Health Insurance Program will be enrolled in the 2015-2016 USHIP, and the corresponding benefits and rates will apply. The 2016-2017 SHIP plan benefits and rates will take effect September 19, 2016 when the academic school year begins. To enroll in the medical coverage, you must submit a receipt from enrollment in the dental and vision coverage, along with the enrollment form and payment. For more information, visit www.shc.uci.edu. For questions about enrollment, please contact Ascension at (800) 537-1777. Find enrollment forms for Early Start enrollment below.

Continuation Coverage
If you graduate during the policy year, you may enroll in the USHIP Continuation Plan for a maximum of one (1) additional term per lifetime, but only if you were covered under the USHIP plan as a registered undergraduate student in the immediately preceding term. Graduating students who enroll in the USHIP Continuation Plan are still subject to the Student Health Referral Requirement, unless you are more than 50 miles from campus or meet one of the other circumstances for waiver of this requirement.

IMPORTANT: Prior to enrolling in the USHIP Continuation Plan, the student is REQUIRED to enroll separately in the dental and vision plan. Dental and vision coverage is through a different carrier and you are NOT automatically enrolled. Graduating students must enroll in the dental and vision plan prior to enrolling in the medical plan, then submit proof of dental and vision coverage to Ascension to enroll in the Continuation Plan. To enroll in the dental and vision plan, call (800) 853-5899. For additional information, please visit www.shc.uci.edu.

Enroll Dependents in SHIP
Dependents enrolling in the USHIP medical plan have the option to enroll in the dental and vision plan, but are not required to purchase the dental and vision coverage. Dependents who are enrolling in the dental and vision coverage must do so prior to enrolling in the medical coverage.
You may enroll your eligible dependents in USHIP coverage online using a MasterCard or Visa by clicking the enrollment link below.

Please note that dependent enrollment is subject to verification of eligibility.

 

 

 

 

This plan has incorporated into the coverage access to a network of medical professionals, including doctors and hospitals, known as the Preferred Provider Organization (PPO), offered through First Health Network. While you are allowed to visit any provider of your choosing, if you use an in-network PPO doctor or facility, you will pay less money out-of-pocket.

Contact the provider prior to your visit to confirm their membership in the network.

Would you like to learn more about the Affordable Care Act and how it applies to your student insurance plan? The handy FAQ below has answers. If you have additional questions, please call us at (800) 537-1777.

The Pharmacy Benefit Manager for this plan is Express Scripts. Only prescriptions filled at Express Scripts pharmacies are covered. Walgreens, CVS, Target, Wal Mart and many other retail stores are in the Express Scripts Network. For additional stores,  call 1-800-447-9638 or visit their website by clicking the link below.

Additionally, please see the Preferred Formulary list and a list of preferred drug exclusions related to this plan.

A mail order discount is available for maintenance medications (taken on a regular basis); pay two copays for each 90-day supply when using the mail order discount program. To sign up, go to the Express Scripts website (link below) and set up an online account. You can also download a mail order form through the link below that you can print out and mail in with a prescription.

Specialty medications are available only through Accredo, an Express Scripts Specialty Pharmacy. For more information, please view the Accredo Information Sheet below.

  • Students enrolled in USHIP must first utilize the services of the SHC, where treatment will be administered or a referral issued. You will be charged a copay and/or coinsurance as indicated in the brochure, but most covered charges will be paid at 100% and the deductible will be waived. Expenses incurred without a prior referral will be reduced to 50% coinsurance. For SHC appointments, call (949) 824-5304.
  • When the SHC is closed or you meet one of the exceptions to the referral requirement, you should go to the nearest PPO Doctor’s office, urgent care, or Hospital. While students may choose any Doctor or Hospital, using the providers available through the PPO networks may greatly decrease your costs. For a listing of the PPO Doctor or Hospital facilities, visit www.myfirsthealth.com or call (800) 226-5116.
  • If you go to a Doctor’s office or to the Hospital, be sure to bring your insurance identification card. If the Doctor or Hospital needs to verify your coverage, they may call Personal Insurance Administrators, Inc., at (855) 515-2423. Carry your insurance ID card with you at all times.
  • If required, obtain pre-certification. Pre-certification is required for scheduled, non-emergency inpatient Hospitalization, as well as certain conditions. Note: The call must be made at least three (3) working days prior to Hospital Confinement or surgery. Pre-certification is not required for Emergency or Urgent Care or Hospital Confinement for maternity care. For pre-certification information or status, contact American Health Holding at (888) 638-5706.
  • In order to process your medical claims it is required that you complete, sign, date, and return this other insurance information form to confirm your insurance coverage status. If you are only insured through your student health plan and do NOT have any other coverage, please check “No,” then sign, date, and return this form. If you to have other health insurance coverage through an employer, parent, spouse, etc., please complete other insurance information, then sign and date the form. You are only required to complete this form once per academic year.
  • After you receive treatment, your provider will submit a claim to the insurance company. Providers should submit claims electronically to PAYER ID 95397.
  •  In some circumstances, such as using a non-PPO provider, you may be asked to pay up front. In this case, submit a claim for reimbursement for the portion of the charges the company is responsible for paying by sending all itemized Hospital and medical bills, along with either a copy of your health insurance ID card or a completed claim form (available at www.4studenthealth.com/uci), to: to:

Personal Insurance Administrators, Inc.
P.O. Box 6040
Agoura Hills, CA 91376-6040

  • A fully itemized billing statement is required for benefit consideration. The fully itemized billing statement should include: 1) the patient’s name and date of birth; 2) the provider’s name, address, and tax identification number; 3) the diagnosis code, date of service, and procedure code; and 4) the amount charged for each procedure.
  • The completed claim, including all Hospital and medical bills, must be submitted for payment within 90 days after the date loss occurs, or as soon thereafter as is reasonably possible. You have the right to request an independent medical review if health care services have been improperly denied, modified, or delayed based on Medical Necessity.
    Always keep a copy of all documents submitted for claims.
  • If you have questions about the status of your claim after it has been submitted, please call Personal Insurance Administrators, Inc., at (855) 515-2423, Monday–Friday, 8:00 a.m. to 5:00 p.m. (4:00 p.m. on Fridays) PT.
  • Always keep a copy of all documents submitted for claims.

If you would like to have confidential medical information from the claims administrator sent to an address other than the address on file with the College, you can download a Confidential Communication Request, fill out the form, and send it to the address listed. This form is available below.

View a glossary of commonly used insurance terms, provided by the Department of Health and Human Services.

After-hours nurse advice line

In partnership with SironaHealth, the UCI Student Health Center offers an after-hours nurse advice line to all UCI students. The Advice Line is a great source of reliable and caring health information, education, and support. If quick, sound medical advice is necessary when the UCI Student Health Center is closed, simply call the UCI Student Health Center at (949) 824-5301 and follow the menu prompts to be connected to specially trained Registered Nurses (RN’s) at SironaHealth Nurse Advice Line.

When do you use it? When the UCI Student Health Center is closed and you need expert medical information and guidance on topics including all types of health questions, tips for how to handle an illness or injury, medication usage and interaction, information about over-the-counter drugs, and information about medical tests and procedures.

How does it work? Call the UCI Student Health Center at (949) 824-5301 after normal operating hours and follow the menu prompts to be connected to specially trained Registered Nurses (RN’s) at SironaHealth Nurse Advice Line. RN’s provide information based upon physician-approved guidelines. Your call is completely confidential.

Note: If you are experiencing a life-threatening medical emergency, please call 911.

More about the SironaHealth After-Hours Nurse Advice Line:
• Translation services for non-English-speaking callers
• TTY/TTD access for the hearing-impaired
• Computerized record-keeping system
• Physician medical director on staff

Get help while you are traveling

As a student participating in this Undergraduate Student Health Insurance Plan, you are automatically enrolled as a Member in the UnitedHealthcare Global Program.

UnitedHealthcare Global is a comprehensive program providing you with 24/7 emergency medical assistance—including emergency evacuation and repatriation—and other travel assistance services when you are outside your home country or 100 or more miles away from your permanent residence in your home country. Expatriates are eligible regardless of distance from  home.

UnitedHealthcare Global provides you with Medical Assistance Services, Medical Evacuation and Repatriation Services, Travel Assistance Services, Worldwide Destination Intelligence, and Security and Political Evacuation Assistance Services. These services are subject to certain Conditions, Limitations, and Exclusions.

For additional information, please see your insurance brochure. To download your UHC Global membership card, see below.