Dependent Benefits
Eligible dependents of fully enrolled/registered UCSF students and researchers may elect to pay and enroll in the Voluntary UC SHIP. Please see Enrollment & Eligiblity for details and an application.
Adult enrolleed dependents 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 and specialty care is covered by the Graduate Student Health Insurance Plan (UC SHIP) as covered by Anthem Blue Cross PPO.
On the UC SHIP website, you can find details and important information about your plan as well as contact information and network providers.
Policy Numbers & Network
| Billing | Member ID | Group Policy | Underwriter | In-California Network | Out-of-California Network |
|
Anthem Blue Cross PPO P.O. Box 60007 Los Angeles, CA 90060-0007 1-800-888-2108 |
Call: 1-800-853-5899 |
275958 | University of California Office of the President |
Anthem Blue Cross PPO 1-800-888-2108 |
BlueCard PPO 1-800-888-2108 |
Insurance Benefits
| BENEFIT | IN-NETWORK | OUT-OF-NETWORK |
| Lifetime Maximum | $400,000 per Plan Year | Not Applicable |
| Annual Deductible | ||
| Individual | $400 | Not Applicable |
| Annual Out-of-Pocket Maximum | ||
| Individual | $6,000 | Not Applicable |
| Hospital Medical Services | ||
|
Inpatient Outpatient medical care Skilled nursing facility Hospice Care Home Health Care |
80% 80% 80%; 100 days max 80%; $5,000 max 80%; 100 visits max |
Not Covered |
| Physician Medical Services | ||
|
Hospital & skilled nursing facility visits Surgeon & assistant; anesthesiologist/anesthetist Primary Care office visits Specialists & consultants office visits Physical, occupational, speech therapy Chiropractic, acupuncture, osteopathic |
80% 80% 80% 80% 80%; $5,000 max 80%; 20 visit max |
Not Covered |
| General Medical Services | ||
|
X-ray, Radiology & Laboratory Testing Durable Medical Equipment Hearing Aids |
80% 80%; $5,000 max 80% |
Not Covered |
| Preventive Care | ||
|
Well child care (birth through age 18) Specified immunizations (birth through age 6) Routine physical exams (age 19 and over) Routine gynecological exams Hearing exams |
100% 100% 100% 100% 80% |
Not Covered |
| Emergency Care, Ambulance & Urgent Care | ||
|
Emergency services & supplies Urgent Care Center Ambulance - Ground Ambulance - Air |
$100 copay; 80% $50 copay; 80% 80% 100%; up to $25,000 |
Not Covered |
| Pregnancy & Maternity Care | ||
|
Physician office visits (pre-natal) Inpatient services |
80% 80% |
Not Covered |
| Behavioral Health/Substance Use Disorder | ||
|
Outpatient services Inpatient services |
80% 80% |
Not Covered |
| Prescription Drugs | ||
|
Generic (Mail order 90 day supply) Brand formulary (Mail order 90 day supply) Brand non-formulary (Mail order 90 day supply) Plan year maximum |
$5 copay ($10 copay) 70% 70% $10,000 |
Not Covered |
Insurance Brochure
Please refer to the Dependent Benefits Chart and Dependent Prescription Summary for details.
