Medical Plan
Enrollees MUST use Student Health & Counseling Services (SHCS) for their primary care and have authorization from SHCS for any specialty care. Care received at SHCS is free of charge.
Medical Plan
| Primary Care Provider: | Student Health and Counseling Services. NO co-pay for care. |
| Maximum Lifetime Benefit: | $250,000 ($100,000 for dependents) per condition per year |
| Annual Out-of-pocket Maximum: | $5000 |
| Annual Deductible: | $250 |
| Office co-pay: | $20 |
| Specialty Visits: | 90% network / 70% non-network / $20 co-pay |
| Outpatient Surgery: | 100% covered |
| Outpatient diagnostic x-rays, laboratory services, casts, splints, and prescribed medicine for emergency care when dispensed at a hospital: | 90% network / 70% non-network |
| Emergency Room: | 100% covered, $50 co-pay |
| Ambulance Services: | 100% covered |
| Hospitalization Services: | 100% covered |
| Hospital Room and Board: | 90% network / 70% non-network |
| Surgeon & Assistant Surgeon: | 90% network / 70% non-network |
| Radiation: | 90% network / 70% non-network |
| Anethesia: | 90% network / 70% non-network |
| Physio/Physical Therapy: | $10 co-pay for first 15 visits $20 co-pay for additional 10 visits not subject to deductible |
| Chiropractic & Acupuncture Care: | $0 co-pay / 15 visits per year not subject to deductible |
| Accidental Injury to teeth: | 90% network / 70% non-network |
| Allergy Tx: | 90% network / 70% non-network |
| Durable Medical Equipment: | 90% network / 70% non-network |
| Prosthetic: | 90% network / 70% non-network |
| Home Care: | 90% network / 70% non-network |
| Medical Supplies: | 90% network / 70% non-network |
| Ortho Supplies: | 90% network / 70% non-network |
| Transgender: | 90% network / 70% non-network |
| Well Baby Care: | 90% network / 70% non-network |
For a list of specific plan EXCLUSIONS, see page 17 of the insurance brochure available.
Policy Numbers & Network
| Billing | Enrollee ID # | Group Policy # | Underwriter | In-California Network | Out-of-California Network |
| Personal Insurance Administrators (PIA) P.O. Box 6040 Agoura Hills, CA 91376 Tel: 1-800-468-4343 |
Download |
302-078-0407 | Nationwide Life Insurance Co. | California Foundation for Medical Care 1-800-334-7341 |
My First Health 1-800-226-5116 |
To get reimbursed for any authorized services that were not billed to the insurance company directly by your clinic of care, submit a copy of your receipt and a claim form to Personal Insurance Administrators.
Insurance Brochure
Please refer to pages 12 to 17 of the UCSF 2009-2010 Student Insurance Plan brochure for a description of the important features of the medical plan.
Insurance Glossary
For a complete list of definitions as provided by Renaissance Agencies, please see Renaissance's Insurance Glossary.
