The results are in: students love UC SHIP! “I love that there's virtually no paperwork to fill out” “It's so easy to use!” “The benefits are great!” ~Spring 2012 focus group with UC SHIP students

All UC Students are required to have a major medical health insurance plan Automatic enrollment in UC SHIP when registered Annual on-line waiver program (through Wells Fargo Insurance Services) Can reverse waiver if lose other coverage Can maintain dual coverage Insurance Requirement

Self-Funded System Wide Plan Medical plan administered by Anthem Blue Cross Fully-insured dental plan through Delta Dental Vision plan through Anthem Blue View Vision-Insight Dental & vision plans cannot be purchased separately Administration

UC SHIP is a comprehensive plan that covers medical, mental health, dental and vision services Fall Semester:August 15 thru January 14 Spring Semester:January 15 thru August 14 Charged Per Semester Total Annual Cost Undergrads $ 891 $1782 Grads $1153 $2306 Premiums

90% Co-Insurance Annual routine physical exam Adult preventative services Generic Prescription copay $5 Prescription annual maximum of $10,000 No maximum visit limit on counseling visits outside of UHS (first 5 visits at Tang are free of charge) 100% coverage for most immunizations (as defined by policy) Physical therapy annual maximum $5,000 In-Network medical and mental health office visits, emergency room & urgent care visits with co-pays are not subject to the annual deductible Great Plan Benefits

Hearing aids (one per ear, every 4 years, in-network providers only) Transplant services as a recipient or donor (includes travel, per plan) Transgender services (Gender Reassignment Surgery) Dependent plan option for children and spouses/same sex domestic partners of enrolled students (dependents will not be seen at Tang) After hours Nurseline available to all UC SHIP subscribers (staffed by Registered Nurses) All graduating students who are on UC SHIP the semester they graduate, have the option to continue UC SHIP for 1 additional semester (a higher premium applies) More Great Plan Benefits

100% coverage of birth control (some conditions apply) 100% coverage of TB screening $15 travel visit copay Increased coverage of major dental services (crowns, inlays & onlays) under the Delta Dental Plan from 50% to 70% New Benefits for

Authorizations University Health Services manages the medical & mental health care of registered students with UC SHIP Except for emergency or urgent care, authorizations are required for all services received outside the Tang Center Bariatric, Transgender and Transplant services must be obtained through an Anthem Center of Medical Excellence and require benefits counseling by the SHIO Case Manager and pre-certification by Anthem

$200 Deductible –Applies to some services provided outside of UHS –Applies per plan year (8/15 through 8/14) Out of Pocket Maximum for in-network providers –$3000 per plan year (doesn’t go toward non-network out of pocket expense) Out of Pocket Maximum for non-network providers –$6000 per plan year (doesn’t go toward in-network out of pocket expense) Lifetime Maximum –$400,000 Benefits Overview

General Benefits –Copay for services rendered by an Anthem Prudent Buyer Network Provider $15 for each primary care office visit, deductible waived $20 for each specialty care office visit, deductible waived –Co-Insurance (subscriber responsibility) 10% In network 40% Out of network (based on allowed rate) Emergency Room –$ copay each ER visit (not subject to deductible) Facility and Professional Services : Plan pays 100% Urgent Care (outside the Tang Center) –$50.00 copay each Urgent care visit (not subject to deductible) Benefits Overview

Acupuncture & Chiropractic –20 visits per plan year ( combined, any combination) –$20.00 copay per visit Rx ($10,000 maximum per plan year) –Prescriptions at the conveniently located Tang Center Pharmacy or from in-network pharmacies when away from Berkeley $5 per generic RX $25 per brand RX $40 non-formulary RX Benefits Overview

MRI ordered by Tang: –$200 deductible applies (if not already met), student pays10% co-insurance after deductible met Orthopedic Consult outside Tang: –$20 co-pay for specialty office visit (deductible does not apply) –May determine MRI is not necessary (no additional cost to student) or… –Specialist orders MRI, $200 deductible applies (if not already met), student pays10% co-insurance after deductible met Examples: Co-Pay/Deductible/Co-Insurance

Ambulance –$200 deductible applies, student pays 10% co-insurance after deductible met for example: Ambulance$1000 Deductible (if not met) -$ 200 (Student Responsibility) Balance$ 800 Anthem pays 90%$ 720 Student pays 10%$ 80 (co-insurance) Examples: Co-Pay/Deductible/Co-Insurance

Mental Health Care Student sees mental health care provider in the Tang Center (first 5 visits are free of charge) When necessary, an authorization for continued mental health care outside Tang Center is granted and names of network providers are provided to student (no limits apply) Student pays $15 copay (deductible waived), Anthem pays (applies to network providers) Provider submits documentation to Anthem’s behavioral health team for outpatient treatment review after the 12th visit to ensure continued treatment is warranted (No action is required by the student)

Delta Dental Preferred Provider Network –110 preferred provider dentists within a 5 mile radius of campus. Benefit limits –Covers up to $1,000 per plan year for all dental benefits Preventative & Diagnostic Services (pays 100% of negotiated fees, no deductible) –oral exams, cleanings, fluoride treatment once every 6months –X-ray Bitewing (once each 24 months) –X-ray Full mouth (once every 5 years) Basic Services ( Pays 80% of negotiated fees after $25 annual deductible) –Fillings & extractions –Endodontics (root canal), Periodontics & Oral Surgery Major Services (Pays 70% of negotiated fees after $25 annual deductible) –Prosthodontics, In-Lays/On-Lays, Crowns & cast restorations Delta Dental

Plan Benefits Eye exam –$10 copay, once every 12 months Frames and lenses OR contact lenses –$25 copay, once every 12 months, up to a $120 value Lens Options –20% discount on lens options such as Transitions lenses, anti-reflective or anti- scratch coatings, UV protection, and others Lasik or PRK Refractive Surgeries – 15% discount Emergency Services –24/7 access Anthem Blue View Vision-Insight

An authorization must be obtained through the Student Health Insurance Office prior to receiving services while away from campus in California, out of California or out of the country (except in emergency or urgent care situations) In California (away from campus) –Authorization request is reviewed by Medical Director for determination. Out of California –Student finds provider (on-line or by help line nurse) in the Anthem Blue Cross network in the area they are visiting. –Claims should be billed to the Anthem Blue Cross claims department in the state that the care was provided. Out of country –Contact the Blue Card Worldwide Service for assistance in obtaining medical care toll free at or collect at –Claims are paid by Anthem at Non-Network rates Out of Area Coverage

Dual coverage? –UC SHIP is primary when used in the Tang Center and Secondary when used outside the Tang Center. In order for Anthem to make payments on claims as the secondary insurance, an authorization is still required. Advice Nurse –Available during UHS regular business hours –Staffed by UHS Registered Nurses After Hours Nurseline –Staffed by Registered Nurses with an average of 19 years of experience. –Urgent & critical care calls are followed closely by nurse line staff and details are provided to Tang Center clinicians. ID Cards/Eligibility –Anthem and Delta Dental use the same 800XXXXX ID Number to identify the eligibility of the student. Miscellaneous