Frequently Asked Questions (FAQs)

Why are UCSHIP premiums increasing and by a large amount?

The sole mission of the not-for-profit University of California Student Health Insurance Plan (UCSHIP) is to offer high-quality, affordable and convenient health insurance. UCSHIP covers medical care on campus and through UC’s world-class medical centers and other providers.

UCSHIP premiums are set according to a projection of expected claims based on the claims patterns from the recent past. UCSHIP total claims volumes and amounts have been increasing for the past two years and have continued to show increases thus far in the 2023-2024 academic year. The largest areas of increase have been in emergency room usage, outpatient mental health services and specialty medicine.

As the volume of emergency room visits by UCSHIP members increased, claim expenses for emergency room services rose by nearly 61 percent over the past two years.

Health Literacy Tip from SHAC: Sometimes you have no choice but to go to the emergency room. However, unnecessary Emergency Room visits drive up the cost of premiums for the entire plan. To learn what conditions warrant an Emergency Room visit versus Immediate or Urgent Care visits, consult The Ashe Center explainer or have a discussion with your PCP during your next visit.

Claim expenses for outpatient mental health services have risen by 78 percent over the past two plan years. The plan has experienced increased use of specialty medications by members, resulting in a 100 percent increase in costs over the past two plan years. Despite the increases, UCSHIP plans offer similar benefits at a significantly lower premium cost when compared to the platinum-level plans available in the State’s Covered California marketplace for individuals.

Health Literacy Tip from SHAC: Despite increases in the UCSHIP premium, the UC student health insurance plan still represents a tremendous value to UCSHIP students. We urge you to research the cost of individual insurance plans on the Covered California marketplace to assess the plans available and determine what plan is best to meet your needs. As always, if the UC student health insurance plan does not make sense for your family, you have the option of waiving UCSHIP during the specified enrollment periods. As students tasked with making decisions about plan administration, we always endeavor to strike a balance between robust, comprehensive benefits that meet student needs while keeping costs as low as possible. We host regular forums and outreach events for student feedback and invite you to come to one of our scheduled, open meetings to voice your thoughts on student healthcare topics at UCLA.

What is UCSHIP doing to avoid the need for such large premium increases in future years?

UCSHIP works with campus student health and counseling centers to help address the needs for student health, including those that are evident in the claims data and those raised by the UCSHIP Executive Oversight Board (EOB), which is made up primarily of student voting members appointed by SHAC, UCLA's Student Health Advisory Committee.

Based on recent trends, efforts are being made to educate students about high-quality primary care options and alternatives to emergency room services, as well as exploring options for after-hours capacities.

Health Literacy Tip from SHAC: As a reminder to students with UCSHIP, The Ashe Center is always your first stop for primary care (PCP) visits when you are sick or in need of a medical appointment. From there, your primary care provider can assess your condition and determine the need for outside referrals to specialist providers. When The Ashe Center is closed or appointments are not available, a UCLA Immediate Care center is the next (and most cost-effective) tier in your UCSHIP plan.

To help mitigate premium increases the EOB voted:

  • to discontinue coverage for GLP-1 and all weight loss medications. GLP-1 for diabetes, however, is still covered.
  • to discontinue the Lyra supplemental mental health care pilot program. Plan members will continue to have access to mental health services through professionals in the campus Counseling and Psychological Services (CAPS) centers and others in the Anthem Blue Cross network and LiveHealth Online.

Why did UCSHIP change emergency room copays, out-of-pocket maximums and coinsurance amounts for specialty medications?

Three key plan design elements are being standardized across campuses to ensure that UCSHIP remains viable for the long-term for future generations of students. The amounts are set at or below market standards.

These are necessary changes in line with accepted practices that help make sure health plans such as UCSHIP are able to attract and spread risks across large numbers of members, as the good health of many helps offset the health care costs of the most vulnerable in our communities.

Across all campuses, the new levels will be:

  • Emergency room copays will be $175 per visit. Note: This fee is typically waived if students are admitted.
  • Out-of-pocket in-network (The Ashe Center, UC Medical Centers and Anthem contracted providers) maximums will be $4,500 for individuals and $9,000 for families, with out-of-network out-of-pocket maximums of $9,000 for individuals and $18,000 for families.
  • Specialty medication coinsurance will be no less than 10 percent, up to $250.

Health Literacy Tip from SHAC: The new levels being implemented as part of this upcoming plan year remain in alignment with Covered California platinum level plan benefits at a lower cost than plans available on the individual marketplace. For questions about this calculation, please feel free to contact our SHAC or The Ashe Center Insurance Office.

Is there any financial relief available to UCSHIP students who have difficulty covering the new out-of-pocket maximum expense?

Yes. Some UCSHIP students may qualify for the Campus Medical Care Assistance Fund (CMCAF). Eligible students can receive a grant to assist them in paying their out-of-pocket medical expenses that exceed $500 up to $3,000. To learn more about the fund and what qualifies for reimbursement, you can visit the dedicated website or contact our in-house Insurance team at The Ashe Center.

Health Literacy Tip from SHAC: Please take advantage of these funds if you are eligible. This reserve fund is underutilized by the UCSHIP community. We are here to help if you have questions about the CMCAF and need support.

When will the new UCSHIP premiums start?

The new premium rates for UCSHIP will take effect at the beginning of the Fall 2024 term.

Health Literacy Tip from SHAC: The Ashe Center Insurance Office has a wealth of information on coverage dates, premium prices, and benefits guides for your UCSHIP policy. The Ashe Center Insurance Office is located at the entrance to the fourth floor of The Ashe Center and is reachable by phone or direct message.

Will UCLA financial aid cover the UCSHIP premium increases?

UCLA expects to cover the UCSHIP premium increase for a portion of our neediest students. Each student’s situation is unique, and they should work with their financial aid officer to understand the impact on them.

Health Literacy Tip from SHAC: The Ashe Center does not make decisions concerning financial aid, so any questions regarding financial aid awards should be directed to the UCLA Financial Aid office. As a general rule, if you receive a financial aid award for student health insurance, this will activate a UCSHIP policy for the entire plan year.

Why was the Lyra program discontinued? How will I get mental health services?

UCSHIP plan members can access mental health services through professionals in their campus’s Counseling and Psychological Services (CAPS) and more broadly through the Anthem Blue Cross network and LiveHealth Online.

Coverage continues to include access to both inpatient and outpatient mental health and substance use disorder care.

Lyra was a supplemental mental health services pilot program. The UCSHIP board voted to end the pilot to avoid the significant premium increases that would have been needed to continue it. Plan members who were using Lyra services will be contacted about transition options.

Health Literacy Tip from SHAC: The last day of effective coverage for the Lyra service is 7/31/24. Be assured the University remains committed to providing quality mental health care. Plan members will continue to have access to mental health services through professionals in the campus Counseling and Psychological Services (CAPS) centers and others in the Anthem Blue Cross network and LiveHealth Online.