UC Student Health Insurance Billing and Claims
Referral Required for Maximum Benefit:
In order to receive the most benefit from your Student Health Insurance Plan, a referral is required for services rendered outside of University Health Services, 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:
After any visit, when you receive a bill, you will also receive an explanation of benefits, 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 Explanation of Benefits or EOB. 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.
What charges you can expect to see:
For services received outside of UHS, from an In-Network provider, you can expect to pay a $500 deductible. After your deductible is paid, you will owe a 20% co-insurance for the remaining balance. For example, if you receive a $1000 bill, you would pay $500 towards the deductible, and then insurance will pay $400, and you would pay the remainder $100, or 20% co-insurance. The maximum per policy year, per person that you will pay is $5000. Please note that if you use an Out-of–Network provider, the deductible is $800, and the co-insurance will be a 60/40 split.
For services received at UHS, for primary care, you can expect that no additional charges will be added to the bill. If you request additional lab work that is not medically necessary, you may receive a bill. You may also receive a bill for durable medical equipment. For mental health and dermatology, you will be charged a 20% co-insurance. These charges will be added to your bursar bill.