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UCLA

 

 

 

 

 

䱸ϴ ACA (ٸɾ) Դϴ

 

 

 

 

UC-Sponsored Student Health Insurance Plan (SHIP)

2017-18 Plan Year Waiver Criteria

 

I.

 

All plans must provide unrestricted access to an in-network primary care provider, in-network hospitalandfull,

non-emergency medical and behavioral health care within 150 miles of campus or the students place of

residence while attending school.

 

NOTE: This criterion applies toallplan types without exception, including Medi-Cal or Medicaid, Medicare,

TRICARE/military, HMOs (including Kaiser, WHA, and others), Covered California or other U.S. federal or state exchange

plans, all employee-sponsored and individual plans.

 

II.

 

Coverage is currently active and the student agrees to maintain health coverage throughout the entire academic

year. If your current insurance coverage is terminated, contact the Student Insurance Office as quickly as possible

to discuss your health insurance options.

 

III.To satisfy UCs health insurance requirement for enrolled students, the plan held by the student must provide the

following (this applies to all students regardless of gender):

 

1)Be a Medi-Cal/Medicaid, Medicare, TRICARE/Military, Covered California or other U.S. federal or state

exchange plan, or a UC Employee Health Plan,OR

2)Be an employer-sponsored group health plan or individual plan that covers the following benefits:

a) Has an annual out-of-pocket maximum of $7,150 orlessfor an individual or $14,300 orless

for a family. Deductibles, copayments, and coinsurance paid by the member accrue toward

meeting the out-of-pocket maximum. A higher out-of-pocket maximum is allowed if the

subscriber has a Health Savings Account (HSA) or a Health Reimbursement Account (HRA)

b) Inpatient and outpatient hospital stays for medical and surgical care

c) Covers inpatient (hospital) and outpatient care for mental health and substance abuse

disorder conditions the same as any other medical condition.

 

d) Doctor office visits for medical, including mental health, and alcohol/drug abuse conditions

 

e) Emergency room and ambulance services

 

f) Medications prescribed by a doctor

 

IV.

 

For international students, the followingadditionalcriteria apply. The plan must:

 

1)Havenoper-medical or per-mental health/substance use disorder condition maximum benefit limits

2)Cover services related to suicidal conditions, including attempted suicide or suicidal thoughts

 

3)Cover medical services for injury from participation in all types of recreational activities or amateur sports

 

4)Not be a health care reimbursement plan with the students home country or another party

5)Not be a pharmacy reimbursement plan with the students home country or another party

6)Havenopre-existing condition exclusion or limitation; if the plan has a pre-existing condition waiting

period, that period has expired

7)Have no lifetime maximums on benefits

 

8)Have a complete master policy written in standard English with benefits expressed in U.S. dollars

 

9)Have a claims payment office with an address and phone number in the United States

10)Pay at least $50,000 annually for medical evacuation

11)Pay at least $25,000 for repatriation of remains

   

 

 

 

 

 

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http://www.studenthealth.ucla.edu

 

https://shb.ais.ucla.edu/shibboleth-idp/profile/SAML2/Redirect/SSO?execution=e1s2 

 

UC SHIP Waiver Application (Please note that 3rd party login id are currently not able to do SHIP transactions. The student themself must do the SHIP transaction.

 


 

http://www.studenthealth.ucla.edu/FormsDocuments/2015-16%20UC%20SHIP%20Cal.050615.pdf

 

 

 

 

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Annual

 

09/25/17 – 09/23/18



 

 

QUARTER STUDENTS: The waiver deadline date is September 20th, 2017.

 

http://www.studenthealth.ucla.edu/FormsDocuments/1819%20UC%20SHIP%20Coverage%20Dates.pdf



 

 

 

 UHC ǥԴϴ.

 

Insurance  Provider

б޺ Blue

UnitedHealthcare()

 

 

Aggregate Maximum

 

 

 

 

 

 Unlimited

 

 

 

 

 Unlimited

 

 

 

Plan year deductible 

 

 

 

º ̿$300

º̿:$500

 

 

 

 

º ̿$100

º̿:$500

 

 

 º̿

ȸ纸

 

In Network : 90%

80%

 

      º

 ȸ纸

 

Out of  Network:60%

70%

Premium

(Annual)

 

Student: $2,225 к

п$3,901

 

 

Student:$1,233

 

 ​​

 

 

 

 

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syracuse university
New York University