Plan Highlights
Adult routine preventive immunizations: Tetanus diphtheria/Pertussis, Measles/ Mumps/and Rubella; Meningococcal, Varicella, Influenza, Hepatitis A and B, Pneu- mococcal, Polio and Human Papilloma Virus (age limit) are covered at 100% at The Ashe Center.
Annual deductible: $200, waived for services at The Ashe Center
In-network coverage: plan pays 90% of in-network hospital, medical, etc. providers
Non-network coverage: plan pays 60% of non-network rates
Prescription drugs coverage: $5 co-pay for generic, $25 co-pay for brand name, $40 for non-formulary, and 100% coverage for prescription contraceptives (some coverage)
Psycho-educational testing: learning disability assessment is covered up to $2,000 per lifetime
Lifetime maximum: $600,000
Coverage period: 365 days of the year, even when travelling
Emergency room: plan pays 100% after $100 co-pay for in-network provider, deductible waived, no Ashe referral required
Urgent Care: plan pays 100% after $50 co-pay for in-network provider, deductible waived, no Ashe referral required, available when the Ashe Center is closed
Students with UC SHIP are expected to seek non-emergency services at the Arthur Ashe Student Health and Wellness Center first after which they can be referred as needed to an outside participating Anthem network provider. The student must obtain a referral from the Ashe Center before receiving non-emergency medical services. Claims will not be considered without the Ashe Center referral.
Students are responsible for no more than $3,000 of out-of-pocket expenses each plan year when using Anthem Blue Cross network providers. If you have paid $3,000 in coinsurance for in-network services (excluding deductibles, Pharmacy copayments, and other co-payments such as office visits), you will no longer be required to pay co-insurance for the remainder of the plan year. The out-of-pocket maximum does not apply to amounts exceeding stated benefit limits (for example, Pharmacy or Physical Therapy limits) or to services not covered by the plan.
For the full policy details for UC SHIP 2012-2013, click here.