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Health Insurance after UC SHIP Individual Health Insurance in California and Other Options. University of California Student Health Insurance Plan (UC SHIP) Office of the President, Risk Services 2012-2013. Insurance Options After UC SHIP. Are You Under Age 26?
University of California
Student Health Insurance Plan (UC SHIP)
Office of the President, Risk Services
Are You Under Age 26?
If you have dual coverage with UC SHIP and your parents’ employer health plan, Health Care Reform law allows you to stay on your parents’ plan until your 26th birthday.
If you dropped your parents’ health plan when you started UC SHIP, Health Care Reform law allows you to re-enroll and remain on your parents’ health plan until your 26th birthday.
You may be asked to provide proof of loss of coverage under UC SHIP to re-enroll. Request a Certificate of Creditable Coverage From Anthem Blue Cross Customer Service—(866) 940-8306
HMO, PPO, & High Deductible Plans
Medi-Cal Programs & Access for Infants and Mothers (AIM)
Questions to ask yourself before you purchase insurance:
Do you have a pre-existing health condition?
A pre-existing condition is a medical condition diagnosed or treated within 6 months prior to your application for Individual health insurance, including pregnancy.
If yes, you may not qualify for an “individual” insurance plan
What is your residency status?
Are you leaving California? You must be CA resident to enroll in California individual insurance plans
What are your health care needs?
For example, do you have a spouse or children?
A plan in which you choose a primary care physician (PCP) who coordinates care with providers in the plan network—no coverage outside network
A plan in which you have direct access to providers in the plan network, as well as non-network providers at higher cost to you
Annual deductible is higher than usual ($1500 or higher) and must be paid before plan benefits are paid.
The maximum amount the carrier will reimburse for a
particular service, sometimes based upon “customary & reasonable (C&R)
For example, UC SHIP’s In Network out of pocket maximum is $3,000
When you are shopping for insurance, do your homework! Make notes on what you will be required to pay for each of the following:
Premium = $$$
Fee you pay to be enrolled in an insurance plan, usually monthly
Deductible = $$ or $$$
Annual Amount you must pay for services out of pocket first, before the insurer will pay for medical and pharmacy services. Other deductibles may apply
Co-Insurance = %
Percentage share of cost expressed in $ for each service (variable; e.g., 20%), after deductible
Copayment = $
Set-dollar share of cost for each service (variable; e.g., $20); not subject to deductible
Balance after You meet the deductible and pay co-insurance or copayment (if any), for each service — subject to policy terms (i.e., for covered services)
To Enroll in UC SHIP for one academic term after graduation, contact:
Wells Fargo Insurance Services
Note: student health insurance plans are not subject to federal or state COBRA laws, so COBRA is not applicable for UC SHIP members who graduate or leave the University for reasons other than graduation.
Most campus Alumni Associations offer health insurance to graduating students—check it out.
Long-term & short-term plans
Plans that accept enrollees with pre-existing conditions
Discounts are available on some campuses, with a health questionnaire
For most campus Associations, the student must join the Alumni Association to qualify for their insurance program
Contact California Insurers or research online:
Kaiser Permanente, www.kp.org
Blue Shield, www.blueshieldca.com
Health Net, www.californiahealthplans.com/healthnet
Rate Determination: Insurance companies rate individuals by age, residence (zip code), and health status
You must complete a Health Questionnaire and qualify for individual insurance to enroll. This is called:
Underwriting—The review of your medical history to assess the RISK of accepting you for policy coverage
Coverage is available for 30 days (minimum) up to 185 days
Also known as “gap” insurance: Check it out at ehealthinsurance.com
Can be extended with limitations — not extendable if any claims in policy period
Ineligible if you have a pre-existing condition
Must be a resident of California
Premiums can be lower than standard individual plans
Short health questionnaire —“streamlined” underwriting
Anthem Blue Cross and Health Net offer short-term health plans:
Caution: If you develop a health condition while on a short-term plan, you may be ineligible later for a standard individual plan
UC SHIP members who leave the University
The California Conversion Clear Protection Plus 5000 plan is an option intended for individuals with serious ongoing health issues. Benefits & Premium vary from UC SHIP.
You must have been covered under UC SHIP for 3 consecutive months prior to applying for Conversion
You must not be receiving health care benefits under UC SHIP or any other group or individual health plan; you must not be eligible for Medicare
You must apply within 63 days of the date your UC SHIP coverage ends.
To access the California Conversion Clear Protection Plus 5000 Plan rates, benefit summary, and application go to ucop.edu/ucship; click on your campus name; then click on Online Medical Services to find the Conversion Plan link. Or call (800) 333-0912.
Government program administered by the Managed Risk Medical Insurance Board (MRMIB) for low-income individuals
Comprehensive medical benefits: physician & hospital services; $500 annual medical deductible
Annual benefit limit of $75,000,
Lifetime limit of $750,000
Must be unable to secure adequate coverage in last 12 months — usually, because student was denied individual coverage by an insurer because of a pre-existing condition
Cannot be eligible for Medicare, COBRA or Cal-COBRA
Must bea resident of California
Participating MRMIP health plans in the Bay Area: Anthem Blue Cross, Kaiser, and Contra Costa Health Plan
NOTE: MRMIP PPO plans may have a 3-MONTH WAITING PERIOD FOR PRE-EXISITNG CONDITIONS
Must have had no health insurance coverage for past 6 months
(a student just leaving UC SHIP would not qualify) No dependent enrollment.
Medi-Cal for Families
Families (adults and children) who are eligible through the CalWORKS program, or a single adult solely responsible for child/children
Pregnancy-related Programs: Medi-Cal and Access for Infants and Mothers (AIM)
Services are provided to women who are under or uninsured — regardless of immigration status. This is short-term coverage; until 60 days after childbirth
Individuals who receive cash aid through certain federal government programs are automatically entitled to Medi-Cal, including CalWORKS and Supplemental Security Income (SSI)
For all Medi-Cal programs, certain financial eligibility criteria apply, and the individual or family may have
a cost-share requirement
Therefore, be an informed consumer:
1. Compare plans and prices
2. Get multiple quotes before applying
3. Know what you are purchasing
Anthem Blue Cross of California — Private health plans, Medi-Cal, AIM & MRMIP: www.anthem.com/ca or (800) 777-6000
Blue Shield of California — Private health plans: www.blueshieldca.com or call (800) 660-3007
Health Net — Private health plans: www.healthnet.com or call (800) 909-3447
Kaiser Foundation Health Plan — Private health plans & MRMIP: www.kaiserpermanente.org/individuals or call (800) 232-5100
Contact county social services in the area where you reside.
Barney & Barney LLC (formerly Saylor & Hill)
Janie Williams at Barney & Barney (888) 334-7259 —
Licensed insurance broker for
Anthem Blue Cross,
Blue Shield of California,
eHealthInsurance — Licensed online health insurance broker www.ehealthinsurance.com
California HealthCare Foundation:www.chcf.org
Kaiser Family Foundation:research and communications about health care and health policy www.kff.org
HealthCare.Gov:official government site provides information on finding insurance options, comparing care quality and understanding the new law www.healthcare.gov
California Office of the Patient Advocate:independent office in state government for HMO members www.opa.ca.gov
California Departments of Health Care Services www.dhcs.ca.gov, Insurancewww.doi.ca.gov, & Managed Health Care www.dmhc.ca.gov
Managed Risk Medical Insurance Board: www.mrmib.ca.gov
Special thanks to the UC Berkeley’s Insurance Office for supplying slides that served as the basis for this presentation.