UC Student Health Insurance Billing and Claims
Referral Required for Maximum Benefit:
In order to receive in-network rates, a referral is required except in cases in which you are more than 50 miles from campus, for ob/gyn or maternity care, or when using an out-of-network provider.
What to expect after a visit:
You will receive an explanation of benefits (EOB), as long as the claim has been processed through your insurance. Anytime you receive a bill for health care services, it is best practice to match it to your EOB prior to making any payments. The EOB will describe the services received, the amount paid by insurance, and the amount due from you. The EOB can be accessed through HealthSmart. Review your EOB to ensure that claims have been fully processed without issue. If you do not receive an EOB please call HealthSmart at 1-800-331-1096.
What charges you can expect to see:
When seeing an in-network provider outside of the University Health Services, you will have an out of pocket expense. At the start of each plan year you must first meet a $500 deductible. After the deductible is met, there will be a 20% co-insurance due. Insurance will cover the remaining 80%. The maximum out-of-pocket paid for a plan year for rendered services is $5,000. For some services, in addition to the co-insurance there will be a co-pay due at the time of service.
For primary care services received at UHS there is typically no out of pocket expenses, as long as the services rendered are medically necessary. If you request additional lab work that is not medically necessary, you will receive a bill. You may also receive a bill for durable medical equipment. For dermatology, you will be charged a 20% co-insurance. These charges will be added to your bursar bill. Most mental health services are at no additional cost.
See the Certificate of Coverage for full benefit details.