SHIP TIPs & FAQs
GENERAL QUESTIONSHow do I get a copy of my insurance card?
I need to get a new referral to continue my care with my non-SHS doctor. What do I do?
Does SHIP provide vision coverage?
Does SHIP provide benefits for pregnancy?
I just graduated. When will my coverage end?
I'm no longer covered under SHIP. How can I prove I had continuous coverage under SHIP?
Does SHIP provide coverage for dental services?
Do I need a referral from Student Health Service to see a dentist?
What are my SHIP benefits for prescriptions?
Do I have to use the Student Health Service Pharmacy?
Will SHS Pharmacy fill a prescription written by a non SHS doctor?
Can I have a prescription transferred to the SHS Pharmacy?
How do I find out about a pending claim?
I received a statement from PIA that says 'THIS IS NOT A BILL". What do I do?
Why is PIA asking for information from me?
I have other insurance coverage in addition to SHIP. Can I still file a claim with SHIP?
Do I have to pay the child premium for each child I enroll in DHIP?
Are dependents required to obtain a written referral from Student Health Services prior to seeking treatment?
Will my dependent receive a Health Insurance card?
How do I file a claim for my dependent?
Does DHIP provide benefits for pregnancy?
How do I get a copy of my insurance card?
A copy of the insurance card can be found on the back page of the SHIP brochure. Brochures are available at Student Health Service (SHS) or you may download a pdf copy here. This card should be carried at all times and presented when accessing medical or dental care.
I need to get a new referral to continue my care with my non-SHS doctor. What do I do?
You should make an appointment with your SHS doctor before your current referral expires. SHS does not provide retro-active referrals. If you are unsure as to when your current referral will expire, you should contact SHS Medical Records to obtain a copy of the original referral. You can visit Medical Records in person at SHS or call them at (858) 534-2139. You may also contact the appropriate SHS Group for the doctor who wrote the referral.
Does SHIP provide vision coverage?
No, however students covered by SHIP receive discounts on services and supplies when using the Student Health Service Optometry Department.
Does SHIP provide benefits for pregnancy?
Yes. Pregnancy is considered the same as any other medical condition. Maternity care benefits are based on the type of service provided. The pre-existing exclusion does not apply to pregnancy or complications of pregnancy. The plan requires that you obtain a referral from SHS for all obstetrical care. Nursery stay for a newborn is considered eligible.
A newborn is covered for any illness or accident for 31 days from birth. To continue coverage for a newborn beyond the first 31 days, you must enroll him/her in the Dependent Health Insurance Plan, whether or not additional premium is required.
I just graduated. When will my coverage end?
Coverage will continue through the last day of the quarter for which you are registered at UCSD and enrolled in the plan. Graduating students enrolled in SHIP during the Spring quarter have continued coverage through the Summer quarter. SHIP does not allow the option to continue coverage beyond your last registered quarter at UCSD.
I'm no longer covered under SHIP. How can I prove I had continuous coverage under SHIP?
You may request, either in writing or by phone, a Certification of Group Health Plan coverage from:
Renaissance Agencies, Inc.
PO Box 2300
Santa Monica, CA 90407-2300
1-800-537-1777
DENTAL
Does SHIP provide coverage for dental services?
SHIP provides coverage for certain dental services. Please refer to the SHIP brochure for a complete list of covered services, benefits amounts, limitations and exclusions. Dental benefits start on page 31 of the2007-2008 SHIP brochure.
SHIP requires that you be covered under the plan for 6 continuous months before becoming eligible for certain services.
TIP! We recommend that you use a dentist in the First Dental Health network to help minimize your out-of-pocket expenses for dental services. You can find a network dentist at www.firstdentalhealth.com. You can even receive discounts on dental services not covered by SHIP when you use a network dentist.
Do I need a referral from Student Health Service to see a dentist?No. We do not have dentists at Student Health Service. You may see any dentist you choose for covered dental services without being seen at Student Health Service first. We recommend using a network dentist. Find a network dentist at www.firstdentalhealth.com.
PRESCRIPTIONS
TIP! Need a refill for a prescription filled at Student Health Service Pharmacy? Do it on-line from the Student Health Service website.
What are my SHIP benefits for prescriptions?
Co-pays vary depending on whether the medication is brand name or generic, whether it is on our formulary list or not, and whether you fill it at the SHS Pharmacy or not. Co-pays are per 30-day supply. Please refer to page 15 of the 2007-2008 SHIP brochure for detailed information regarding prescription coverage.
Do I have to use the Student Health Service Pharmacy?
No. SHIP provides benefits for prescriptions filled at a non-SHS pharmacy. Keep in mind however that you will be required to pay the full cost of the medication at a non-SHS pharmacy and then file a claim for reimbursement. The claim will be subject to the plan year deductible, and reimbursed at 50% after the applicable co-pay.
TIP! Need over the counter medications? The Student Health Service carries a wide range of discounted products not requiring prescriptions. Prices are generally lower than retail stores.
Will SHS Pharmacy fill a prescription written by a non SHS doctor?
Yes. You may call the SHS Pharmacy at (858) 534-2135 to check on the availability of a specific medication.
Can I have a prescription transferred to the SHS Pharmacy?
Yes. Just call the SHS Pharmacy at (858) 534-2135 and provide the name and phone number of the pharmacy currently filling the prescription, along with information about the prescription you want to transfer.
CLAIMS
TIP! You are financially responsible for any charges you incur, regardless of whether your insurance is expected to pay or not. If you receive any statements from Personal Insurance Administrators (PIA) or from a provider of service, it is your responsibility to follow up and ensure that the charges are paid, either by you or by the insurance plan, and that you respond to all requests from PIA for additional information in order to process your claim.
How do I find out about a pending claim?You may contact PIA for all claims inquires at 1-800-468-4343.
The doctor (or hospital) is billing me, but I have insurance. What should I do?You should contact the provider of service to discuss the charges further. If they (or you) have already filed the claim with the insurance company, you should contact PIA to verify the status of the claim. If the claim has already been considered, you should verify the amount you are responsible for paying and then contact the provider of service to discuss payment options. If the charges have not been filed yet, and the provider has agreed to file the claim on your behalf, give them your insurance information. I received a statement from PIA that says 'THIS IS NOT A BILL". What do I do?
When PIA processes a claim, they will send to you an Explanation of Benefits (EOB). The EOB will tell you whether charges were denied, applied towards your deductible or co-pays, or how it was paid. The EOB will also reflect the "Patient's Liability" which is the amount you will owe the provider of service. That amount does not include any payments you may have already made to the provider. It is important that you follow up with the provider to confirm that their records reflect any payments made by you or PIA. You should be able to match up the EOB(s) with any bills you received from the provider. If the totals do not match, you may call PIA to discuss the EOB(s) further. You may also call or visit the Student Health Insurance Office for assistance.
Why is PIA asking for information from me?
PIA requires a claim form from you in order to consider any charges. The claim form contains important information that they need in order to review your claim, and also allows them to request information from providers, if necessary. Sometimes they require additional information such as prior medical history, other insurance coverage or accident details. It is very important to complete the requested form(s) and to supply the requested information so that PIA can continue the processing of your claim. If you fail to supply the requested information, your claim may be delayed or denied.
I have other insurance coverage in addition to SHIP. Can I still file a claim with SHIP?
SHIP is secondary to any other benefits payable under any insurance, health maintenance, prepaid or any other health care delivery plan. All claims should be filed with your other insurance first. The explanation of benefits from your primary insurance plan should then be forwarded to PIA so that SHIP may consider the claim as secondary.
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.
DEPENDENTS
TIP! Do not wait until the last minute to re-enroll your dependents. You run the risk of missing the enrollment deadline. Stop by the Student Health Insurance Office early to complete the enrollment application and drop off your payment. Enrollment applications and checks are not sent to the insurance company until the last day of the enrollment period.
Do I have to pay the child premium for each child I enroll in DHIP?
No. You do not pay the amount for each additional child. You pay the child premium for child coverage, whether you have one child or more than one.
Are dependents required to obtain a written referral from Student Health Services prior to seeking treatment?
No. Unlike SHIP, DHIP does not have a referral requirement. Student Health Services is a private facility that only services registered students. Dependents are not eligible to use SHS.
Will my dependent receive a Health Insurance card?
Dependents are not provided with personalized insurance cards. A generic insurance card is provided on the back cover of the DHIP brochure. The policy number and claim filing address are indicated on the perforated card.
How do I file a claim for my dependent?
Follow the same claim filing process as for students. Click here for claim information.
Does DHIP provide benefits for pregnancy?
Yes. Pregnancy is considered the same as any other medical condition. Maternity care benefits are based on the type of service provided. The pre-existing exclusion does not apply to pregnancy or complications of pregnancy. A newborn's nursery stay is considered eligible. A newborn is covered for any illness or accident for 31 days from birth. To continue coverage for a newborn beyond the first 31 days, you must enroll him/her in the Dependent Health Insurance Plan, whether or not additional premium is required.
