How to Use SHIP

Important referral requirements

When receiving care within a 100-mile radius of UCSD, benefits for covered charges incurred are available only upon referral from the UCSD Student Health Service. This referral requirement does not apply in the event of an emergency; however a written referral from SHS is required for any follow-up care after emergency services. A referral from an Emergency Room doctor is not a valid referral.

When treatment for a condition is required from a provider other than the provider for whom the SHS originally referred the insured student, a new referral must be obtained*.

NO BENEFITS ARE PAYABLE when covered charges are incurred within a 100-mile radius of UCSD in the absence of a SHS written referral or emergency. Please note the outpatient deductible will increase for non-emergency outpatient treatment rendered outside of a 100-mile radius of UCSD without a referral.*

*Please refer to page 10 of the SHIP Benefits brochure for complete information regarding referral requirements.

When do written referrals expire?

Each written referral for a condition is valid for the number of visits or time period indicated on the referral form. In no case is the referral authorized for more than 365 days.

Medical services outside a 100 mile radius of UCSD

When outside 100 miles of UCSD, students may access care directly and no referral is required. However, the outpatient deductible will increase in the absence of a written referral from SHS. Students are encouraged to utilize the PPO networkto ensure the highest level of coverage for eligible services.

Emergency room services

In the event of a medical emergency, proceed immediately to the nearest medical facility. Using a UCSD facility (UCSD Thornton or Hillcrest), or facilities within the SHIP network, is most cost effective.

Eligible services through Thornton Hospital (located on the east end of campus) would be covered at 100%, after deductible and co-pay have been satisfied. Eligible services through a non-UCSD affiliated provider would be covered at 80% after deductible and co-pay.

If follow-up care is required after the emergency room visit, a written referral from a SHS PROVIDER is required. If a written referral from a SHS provider is not obtained prior to services being rendered, coverage and payment will be denied and the student will be responsible for all charges. A referral from an emergency room doctor is not a valid referral.

What to do AFTER an Emergency Room visit
Read this helpful "Emergency Room Resource Sheet" with information about campus resources you may need after you've been to an Emergency Room. Included are: Student Health, SHIP, Deans' Offices, Res Life, Psych & Counseling Services, Disabled Student Services, and Sexual Assault & Violence Prevention.

Effective 9/24/07: Important Pre-certification and Continued Stay Review Requirements

Non-Emergency Hospitalizations: Pre-certification must be obtained prior to all planned admissions. Certification for continued stay beyond original certification must also be obtained. $250 penalty will apply for non-compliance.

Emergency Hospitalizations: Certification must be obtained within 24 hours of admission, or as soon as reasonably possible, for all unplanned, emergency admissions. Certification for continued stay beyond original certification must also be obtained. $250 penalty will apply for non-compliance.

Surgery: Pre-certification must be obtained prior to all planned surgeries, or as soon as reasonably possible following emergency surgery. $50 penalty will apply for non-compliance.

Certification is required for all inpatient hospital stays and for all surgeries. It is the student's responsibility to ensure these requirements are fulfilled. Please refer to page 9 of the SHIP brochure for a complete description of the Pre-certification requirements.

For notification and continued stay review, please contact First Health Network toll-free at 1-800-572-5508. This number is included on the SHIP ID Card for easy reference.

How do I find a Preferred Plan Provider in California?

To locate a provider out of the 100 mile radius of UCSD, you can access the California Foundation for Medical Care network website at www.cfmcnet.org or call them directly at (800) 334-7341.

To locate a provider outside of California, you can access the First Health Network (FHN) website at www.myfirsthealth.com or call them directly at (800) 226-5116.

Please be aware that if you are treated at a PPO hospital, it does not mean that all providers at that hospital are also PPO providers.

I have other insurance coverage and SHIP, which one is primary?

SHIP is secondary to any other benefits payable under any insurance, health maintenance, prepaid or any other health care delivery plan.

Although SHIP is considered secondary, you are still required to follow all pre-certification and referral requirements under SHIP.

If your primary insurance is an HMO and is not expected to pay any benefits, SHIP still requires that the claim be filed with your primary insurance plan so that they may formally deny liability on the claim. The explanation of benefits from your primary insurance plan should then be forwarded to PIA (the claim administrator for SHIP) so that they may consider the claim as secondary.

What prescription benefits do I have?

SHIP provides benefits for covered prescriptions. Refer to the SHIP brochure for co-pay and benefit information. You are encouraged to fill your prescriptions at the Student Health Service Pharmacy to maximize your insurance benefits.

You may call the SHS Pharmacy directly for questions regarding availability of specific medications, refills, transferring prescriptions or general questions for our pharmacists.

Refer to SHIP TIPS & FAQs for Frequently Asked Questions about how to file a claim.