The BRB Bottomline: Time to make sense of all that health insurance jargon that makes you feel sick in the stomach. Stick with us as we deconstruct health insurance and break down what Student Health Insurance Plan (SHIP) does for you.
Does this sound familiar: It’s week five of the semester, the midnight oil is burning, and midterm season has descended upon campus like a swarm of locusts—prophesied and expected, yet nonetheless devastating. You watch in mounting dread as that sinister cough jumps from student to student, roommate to roommate, till it’s the eave of your midterm and you’re stuck in the shared bathroom throwing up yesterday’s overpriced Bay Area lunch, wishing you had some medicine.
Look no further, we’ll help jumpstart your health insurance education, so you can get the medicine you need, and get back to studying for your midterms.
What is Health Insurance and SHIP?
Health insurance is insurance offered to an individual to pay for medical and healthcare expenses. In the U.S., healthcare is offered both through private, corporate, and public providers. The government offers health insurance for low income and elderly people nationally through Medicaid (need-based) or Medicare (age-based).
The Student Health Insurance Plan (SHIP) is a comprehensive major medical plan offered to all UC Berkeley students that provides coverage for all the medical, counseling, prescription, vision, and dental expenses you might have. All medical care has to begin with University Health Services (UHS), also known as the Tang Center, except for emergency room or urgent care services. The semester cost of SHIP varies depending on whether you’re an undergrad ($1,497), grad ($2,373), or if you have dependents (cost varies per number of dependents).
All students are automatically enrolled in SHIP, however, students can waive the health insurance in favor of their own insurance plan if their family’s plan is more affordable or convenient. Last year, the deadline to waive your SHIP insurance was July 15th; waivers submitted after July 16th through July 31st incurred a $75 late fee. The Tang Center is available to all students regardless of whether or not one is enrolled in SHIP.
Health Insurance Terminology
Health insurance is complex, kinda boring but very important, so it’s important you understand the terminology of health insurance before we continue:
Benefits: the coverage afforded to an individual per one’s insurance plan.
Co-Pay: fixed out-of-pocket amount for covered services. This is a cost you have to pay each time you go to the doctor or fill a prescription.
Deductible: the amount that an individual has to pay out-of-pocket each year for covered services before health insurance coverage kicks in for any subsequent services; co-payments don’t count towards this total.
Dependent: an individual who depends on another for financial support.
Coverage: the percentage of medical costs that your insurance plan will cover of any given service.
HMO vs. PPO
Health Maintenance Organization (HMO): HMO plans offer an entire network of health providers at your disposal, including a Primary Care Provider (PCP). HMOs tend to have lower premiums and deductibles, however, to see specialists requires referrals, and services outside your network will have no coverage.
Preferred Provider Organization (PPO): PPO plans offer more flexibility to see providers outside of your network, however, premiums and deductibles tend to be higher.
In-Patient Care: medical care administered in a hospital that requires at least an overnight stay.
Outpatient Care: medical care administered in a hospital that usually doesn’t require an overnight stay.
In-network vs. Out-of-network: the amount of coverage afforded to you may change depending on whether you are getting service from a health provider within or outside of your health insurance network.
Premium: the amount paid regularly for insurance coverage.
So how does SHIP work for you? Please refer to this chart for the go-to points about SHIP. For a full, comprehensive list of all costs and benefits, please visit the Tang Center website.
What’s important to note is that you have no deductible when paying for services within Tang, however, for services rendered outside of the University, you must first pay down your deductible ($300) before SHIP kicks in.
Anthem Blue Cross is the network provider for SHIP. When possible, always try to stay within the Anthem Blue Cross Network to receive better rates: 90% for in-network coverage vs. 60% for out-of-network coverage. For treatment outside of Tang, you have to fill out a referral form before services are rendered otherwise SHIP may not cover your visit; the exceptions are emergency room or urgent care visits, prescriptions, international services, and limited preventative and women’s health visits.
Take Home Points
Now that you have a better grasp of health insurance jargon and terminology, do your research before committing to a health insurance plan (as with anything). Plan ahead and choose the plan that most benefits your situation and…
Remember that the Tang Center exists for your benefit. Don’t not hesitate if you need urgent care or emergency treatment: the monetary cost is less than the worth of your health!