Graduate Student Health Insurance Plan

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QUESTIONS AND ANSWERS
Graduate Student Health
Insurance Plan (GSHIP) 2009- 2010

Health Insurance is mandatory for all graduate students at UCSB. You will automatically be enrolled in GSHIP unless you waive out. The plan year dates are September 20, 2009 through September 18, 2010, with premiums paid three times a year. Dependents must enroll four times per year - the enrollment form is on the Student Health Service website. If you have comparable independent insurance coverage and can access primary care within 25 miles of UCSB, you may submit a Waiver Request form to waive out of GSHIP. Please read the brochure for a full understanding of benefits. Your identification card may be printed from the website in September. It should be carried with you at all times. Insurance information, including the brochure, waiver request form and claim form, are available from the Student Health Service (SHS) website at:

www.sa.ucsb.edu/studenthealth/insurance

Also available at this website is a “How To…” document for graduate insurance It is suggested that you read this document in conjunction with this Question and Answer text.

What’s new for 2009-2010(by graduate student vote)

Immunization benefit expanded to include flu shot and Pneumococcal, and Hepatitis B benefit increased to 100% ($300 annual maximum). Benefit only applicable to immunizations at Student Health Service – deductible waived. See brochure for list of covered inoculations
Accutane benefit increased to same as other eligible medications (previously paid at 75%)
HIV testing – one visit per year at Student Health Service - no cost to student
Pap test - one per plan year at Student Health Service - no cost to student
Air medical emergency transportation increased to $20,000.
Ability to purchase two quarters continuation of coverage following graduation
Five non post-surgical off campus physical therapy visits.
Mental Health outpatient – Pre-existing clause does not apply; deductible waived for all mental health conditions.

Cost

Students: $721.25/quarter; the annual cost is $2163.75

Students on Approved Leave: $754.25/quarter

Spouse/domestic partner: $1643/quarter (paid four times a year)

Child(ren): $812/quarter (paid four times a year)

How do I access healthcare?

Please see the companion document entitled “How to…” for details on how to access health care locally and worldwide. Also included in that document is information on how to deal with problems with medical bills.

What is a deductible?

A deductible is the amount of money for which you are responsible before the insurance company pays any eligible expenses. You have a $300 deductible per academic year, September to September. The deductible requirement begins again with the new plan year (each September). In addition to the deductible, there is also a $100 per visit emergency room copay which is waived if admitted to the hospital.

What is coinsurance?

Coinsurance is the portion for which you are responsible after your deductible has been satisfied. If you have already satisfied your $300 deductible and your total bill is $200, 20% coinsurance amounts to $40; 50% coinsurance is $100.

What is a copayment?

A copayment is a predetermined charge that you pay for a particular service. Your pharmacy copayment is $25 for a 30-day supply of a prescribed medication. If the prescription costs less than $25 and is filled at SHS, only the cost of the prescription is charged.

How does the six-month pre-existing condition clause work?

If you have been seen for an illness within six months prior to enrolling in SHIP, your condition is considered pre-existing and will not be covered by benefits for six months.However, if you had other comparable insurance with not more than a 63-day lapse between insurance plans, the pre-existing clause is waived.Please see the brochure for a more detailed explanation.

What is the Foundation for Medical Care?

The Foundation for Medical Care is the Preferred Provider Organization (PPO) for GSHIP. It is a regionally divided, statewide-managed care group that contracts with hospitals and physicians for reduced member rates. Members have access to any Foundation provider in the state of California If within a 50-mile radius of UCSB, you must first visit Student Health Service (except in case of an emergency.) If medical services are required that SHS cannot provide, you will be referred to an outside provider. You may pick up a list of local PPO providers from an Insurance Advisor in SHS or print from www.cfmcnet.org. After your deductible has been met, you are eligible for 80% reimbursement only when you visit a member of the Foundation – 50% when a provider is not a member of the Foundation (except in emergencies.) You are responsible for any additional charges not covered by your policy. It is your responsibility to verify your charges. Reimbursement is based on eligible expenses. Please see the GSHIP brochure for more details about the Foundation and for a definition of eligible expenses. Please see the GHSIP brochure for more details about the Foundation for Medical Care and for a definition of eligible expenses.

What is First Health Network?

First Health Network is the Preferred Provider Organization (PPO) for GSHIP outside of California. Members have access to any First Health provider in the nation. The number of this organization is on your identification card. The same benefits apply as with the Foundation for Medical Care network (see details in question immediately above this one.)

How much do I pay for my prescription medication?

There is a $25 copayment for a 30-day prescription, $40 for 60 days and $50 for 90 days. After this copayment, coverage is as follows:

1.100% if filled at the SHS

2.100% if filled outside of SHS if the medication is not carried at SHS

3.100% if filled outside of SHS if SHS is closed on that day

4.100% if filled more than fifty miles from UCSB

5.50% if filled outside SHS for convenience

The deductible, secondary insurance and pre-existing condition clauses do not apply if your prescription is filled at SHS, if SHS does not carry the medication, or if you are outside a 50-mile radius of SHS.

If your prescription is filled outside of SHS, you will have to pay the full cost of the medication. To receive reimbursement, you must send your receipt, a claim form and a note stating the medication is not available at SHS (if applicable) to the claims administrators (PIA.)

Do I have to pay for x-rays and laboratory fees at Student Health Service

The x-ray and laboratory fees at Student Health Service are covered under your insurance plan. However, you will still be charged for lab tests which must be sent outside of Student Health for results. These charges are eligible expenses, and you may submit a claim for benefitsn to the insurance company (deductible applies, as with all benefits except pharmaceutical).It is your responsibility to inquire about any charges.X-rays required for physical examinations are not covered as the insurance benefits only cover sickness and accidents.

Is there a monetary limit to what the insurance will pay?

There is a $300,000 maximum benefit for each accident or illness, renewable each plan year. There is an $8,000 per year maximum prescription benefit. This cap applies to the actual cost of the medication, not the copayments.

Is there a monetary limit to what I will have to pay?

Yes. There is a $4,000 “stop loss” benefit, which means that after you have paid $4,000 in out-of-pocket eligible expenses (coinsurance, copayments, deductible all included), the insurance company will pay all eligible expenses above this amount up to the relevant benefit maximum, if you use only network providers. This amount increases to $5,000 if out-of-network providers are used, so it’s possible to have a $9,000 out of pocket expense if network and non-network providers are utilized.

Does Student Health Service bill the insurance company for me?

No, Student Health Service provides no insurance billing except for prescriptions filled at SHS. All PPO providers outside of SHS, however, have agreed to bill the insurance company. You are responsible for submitting a claim form to the claims administrators (PIA) for each eligible medical expense. You may submit a claim online at www.PIAclaims.com.Another option would be to complete a claim form available at www.sa.ucsb.edu/studenthealth/insurance.If you have questions, please contact an Insurance Advisor at (805) 893-2592 or email:Insurance@sa.ucsb.edu.

Am I covered during the summer and during school breaks?

Yes, but only if you were a registered student for the preceding quarter. The Spring Quarter insurance premium for graduate students provides coverage throughout the summer until the new policy begins in September. A dependent must enroll for each term in which they wish to be enrolled, including summer.

Does my insurance cover routine eye and dental care?

Student Health has a vision plan that provides discounts for routine vision care provided at the Student Health Eye Clinic. Care for medical conditions affecting your eyes is covered under your medical plan. Please refer to the online brochure for specifics regarding this coverage. Your insurance covers accidental injury to natural teeth (see brochure), and includes a SHS administered dental plan.The $50.00 quarterly charge for this plan is built into your GSHIP fees.For no additional charge, you received one annual exam with x-rays and two routine cleanings per year with a $15 copayment for each. For details, please see the SHS Graduate Dental Clinic Plan pages in your brochure. The Dental Clinic plan applies to graduate students only, as spouses/dependents are not seen in the SHS Dental Clinic.

Is Physical Therapy covered?

After satisfying your deductible, Physical Therapy is covered at 100% up to a maximum of $500 per condition per year if received at Student Health Service, and the post- surgical requirement does not apply (physical therapy only covered outside of Student Health if following surgery). SHS has a high-quality Physical Therapy Department that you may access with a referral from a practitioner. Physical Therapy services received at a facility outside of SHS are covered post-surgically only, with benefits at either 80% (PPO) or 50% (non-PPO) up to a maximum of $500 per condition per year.

Is pregnancy covered?

Yes, pregnancy is covered at the same benefit level as any other medical condition. California Code mandates that the six-month pre-existing clause does not apply to pregnancy. If you are pregnant before you enroll in GSHIP and have not been covered by a comparable insurance plan, you will now receive benefits from your enrollment date. A newborn baby is covered for any illness or accident for 31 days. A newborn’s nursery stay is an eligible benefit. To continue a newborn’s coverage beyond 31 days, you must enroll him/her in the insurance plan whether or not an additional premium is required.

Do adult dependents enrolled in GSHIP have to first be seen at Student Health Service?

Yes, unless they are more than fifty miles from UCSB. There is a visit fee charge for all non-students using SHS. This fee is an eligible insurance benefit and you will need to file a claim form with the claims administrators (PIA). Children are not seen at SHS, so if your child is covered by this insurance, you may go to a provider of your choice. Remember, reimbursement is at 80% for a provider/facility who is a member of the Foundation for Medical Care and 50% if the provider/facility is not a member.

Are there other insurance alternatives besides the GSHIP plan?

You may choose to call an independent company to inquire about their rates for your dependents or access the website www.ehealthinsurance.com/ehi/index.html for other insurance options.

Can I purchase this insurance if I am on approved leave?

Yes. You must send an enrollment application (in the brochure and on the website), your payment and a copy of your approved leave document to Renaissance Agencies. The premium for students on leave is slightly higher than for registered students as SHS does not receive operating funds for non-registered students. You may enroll in GSHIP for no more than four quarters total (please note the spring term counts as two quarters as it includes summer) while on approved leave. The quarters need not be contiguous. Remember – you are not automatically enrolled in GSHIP unless you are a fully paid, registered student.

What if I require emergency medical attention in a foreign country?

As an insured member of GSHIP you are automatically enrolled as a Member in the MEDEX program. MEDEX provides assistance for emergency medical services and evacuations, if necessary. This includes emergency medications, legal assistance, translation services and more. Please see your brochure for a full explanation of these services. The 24-hour toll-free (or collect call) numbers for assistance are (800) 527-0218 or (410) 453-6330.

What if I am a new student and my department requires me to be in Santa Barbara prior to the September 20 beginning plan date?

If you are required to be in Santa Barbara before September 20 for matriculation purposes, either bring University documentation to that effect to the SHS insurance office or have your department e-mail this request to the Insurance Coordinator and your coverage may begin early, but not prior to September 1. This does not apply to the Teacher Education Program students, as their insurance is mandatory from the beginning of their summer program.

I am in the Teacher Education Program – When Does my Coverage Begin?

Insurance is mandatory for the Teacher Education Program (TEP), and you are assessed the premium on your BARC statement. Your insurance coverage begins the first day of your program (see brochure for dates of coverage).

What can we do as students to help keep the insurance premiums down?

This is important, because the more expensive the service the higher the premium will be for next year. You can do four things:
1) Utilize the Student Health Service
2) Avoid referrals of convenience
3) Use preferred providers whenever possible
4) Utilize Urgent Care Centers vs. Emergency Rooms when applicable if SHS is closed.See brochure for definition of emergency.

I don’t have time to read the GSHIP brochure – how can I get more information and have my questions answered?

While we are happy to answer your questions, it is YOUR RESPONSIBILITY to read the information provided in order for you to have a good understanding of your policy and its benefits, limitations and exclusions. GSHIP brochures and claim forms are available at SHS and from the Website www.sa.ucsb.edu/studenthealth/Insurance. If you do have questions, you may call the claims administrators (PIA) directly (1 800-468-4343), or email Insurance@sa.ucsb.edu.

I have concerns with various aspects of GSHIP. With whom may I talk?

The Graduate Students Association meets, discusses, negotiates and votes on each phase of GSHIP. These meetings occur monthly during the school year, and anyone interested is welcome to attend. To ascertain dates and times and/or to place an item on the agenda, please contact the GSA GSHIP Committee by calling the GSA at (805) 893-3824, sending an email to, or visiting the GSA website at to find the names and contact information for GSA representatives to the GSHIP Committee. You may also contact the SHS Insurance Coordinator, Elaine Grimmesey, at (805) 893-6133, or by e-mail at Grimmesey-e@sa.ucsb.edu.

I’m graduating. How can I document that I have had continuous insurance coverage?

You may request, either in writing or by phone, a Certification of Group Health Plan Coverage from

Renaissance Agencies, Inc.
P.O. Box 2300
Santa Monica, California 90407-2300
Phone: (800) 537-1777