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INSURANCE ELIGIBILITY *

Effective Date: 
Fri, 01/09/2015
Reviewed: 
Mon, 04/23/2018
Revised: 
Tue, 01/07/2020
Policy: 

UCSC students must all have health insurance.  The SHS Health Insurance Office tracks the health insurance option that the student maintains, in order to ensure that the students have health insurance.

Students are automatically assigned UC SHIP, University of California Student Health Insurance Plan and may waive it with proof of suitable insurance, based on UC-wide waiver criteria.  This includes students "in absentia".

Addressing inconsistencies may be required for withdrawals, leave of absences, late waivers, late enrollments etc.  For the process to address these, see the Procedure.

Procedure: 

WITHDRAWALS - also see policy on Medical Withdrawals

IN ABSENTIA - These students are required to have health insurance however they will be part of a different insurance group.  Insurance staff will document this status in the EMR and the database.  They may be seen at the UCSC Student Health Center.

PLANNED EDUCATIONAL LEAVE (PEL) does not apply at UCSC

LEAVE OF ABSENCE (LOA)

Note: A leave of absence is a type of withdrawal - with the intent and option to return.  If the leave of absence begins after the quarter starts, the Undergrad is on UC SHIP unless they request to rescind the insurance and it has not been used. If a Grad student is on leave of absence and files their leave before the first day of the quarter, or after the first day of the quarter and not enrolled, or after the first day of instruction.  They will not remain on our enrollment roster and the UC SHIP charge will be reversed.

Only students on UC SHIP the previous quarter may voluntarily enroll in UC SHIP after the current quarter, by "voluntary" enrollment through USI Insurance Services.  This is allowed for up to two ensuing quarters, once in their academic career, (Spring is combined with Summer).

Documentation of voluntary enrollment:

- Receipt of email notification of voluntary insurance enrollment by USI sent to Insurance staff

- insurance database updated by Insurance staff

- electronic medical record updated by Insurance staff as on "voluntary UC SHIP", and NOT eligible to use SHS

Note: Those on voluntary insurance will be given a general care referral from UCSC SHS.  

If the student does not have UC SHIP or is early enough in the quarter and chooses not to keep UC SHIP

Documentation of the LOA:

- insurance database updated by Insurance staff

- electronic medical record updated by Insurance staff "not eligible" (make sure the student has been credited in AIS)

This change will automatically be updated for our waiver administrator.

LATE ENROLLMENT

Make sure that the insurance database is correct and add the information to the electronic medical record.  Ensure that the student is charged the UC SHIP premium in AIS (if they do not have other health insurance or appropriately waived) if not in the next update, then manually.  The other updates should be done automatically.

For Late CruzCare enrollment, notify Billing.

Documentation for late enrollment in UC SHIP:

- Insurance Database updated by Insurance staff

- EMR updated by Insurance staff

- Checking for charge in AIS - check date; student may have a reg form from Registrar's Office that Insurance staff documents their initials and documents whether to keep UC SHIP or waive.  If student wants to waive, Insurance staff provides late waiver opportunity.

LATE WAIVER (as of closure of waiver site)

Document the waiver results in the database and update the electronic medical record.  The credit will appear in the Academic Information System (AIS) with the weekly updates.

Documentation of late waiver:

- Insurance Database by Insurance staff

- EMR by Insurance staff

- Charge the late waiver fee

NOT ENROLLED / NOT A STUDENT

When a student shows that they are not enrolled, but the rosters for UC SHIP Insurance show that the insurance is active, when the student shows up at the Student Health Center, determine that the student did not voluntarily purchase the insurance via the waiver administrator.  If the student did not enroll in the UC SHIP plan voluntarily, and did not pay for insurance, insurance staff would check AIS to see if billed and paid, and if did not purchase UC SHIP, edit/document in the electronic medical record that the student is not enrolled and is not eligible for services.  If services were rendered and the insurance plan was billed, contact the insurance plan to rescind those claims.  Inform billing via IM.  If there are outstanding bills, the remittance of payment is the responsibility of the patient and the patient should be notified via secure message.

Documentation for Not Enrolled Student:

- Insurance Database by Insurance staff in the Admin Notes (further updates done automatically)

- EMR by Insurance staff

- Insurance Carrier if claims need to be rescinded (by Billing staff)

- AIS if charges need to be added

REFUNDS

Our policy follows the guidelines set forth by the UCSC Registrar's Office regarding refunds.

For Withdrawals / LOA's - If the student withdrew prior to the start of the quarter, then they get a full refund of the insurance premium.  If the student withdraws in the first week within the quarter, then the student will show as having UC SHIP and can petition to get off the insurance and get a refund.  If a student withdrew after the first day of instruction, they will remain on the insurance for that quarter.

 

PROCESS FOR PATIENT CONTESTING FEES *

Effective Date: 
Wed, 10/29/2014
Reviewed: 
Wed, 03/28/2018
Revised: 
Wed, 03/28/2018
Policy: 

The UCSC Student Health Services (SHS) will address requests to reconsider fees that were incurred in the provision of health services.

Fees for  "outside paid services" like reference lab testing, and for consumables like prescriptions or medical supplies, in general, will not be considered.

The Billing staff member cannot reverse fees without manager authorization, notably when the fees have been posted to the Academic Information System (AIS).

UCSC SHS staff cannot reverse late fees.  The student can contact Student Business Services with that request.  Occassionally, the UCSC staff, Billing or managers, may request reversal of late fees from SBS if appropriate and due to SHS actions.

Procedure: 

Procedure for handling requests.

Note: Any communication from Billing or other staff will not guarantee nor infer that fees will be reversed, including late fees which can only be addressed by Student Business Services (SBS).

SCENARIOS

1. Patient comes to the SHS to contest fees. 

The Billing staff member sends a linked secure instant message (IM) to the Billing Supervisor with the request. 

Billing Supervisor Action - The chart is reviewed and potentially referred to another manager for input.  The outcome is communicated to the Billing staff member and action is taken by the Billing staff member if required.  If no billing action is required, a secure message with the appropriate response is sent to the student by a manager.

2. Patient telephones / leaves a message with Billing.

The Billing staff member recommends putting the request in writing and sending it to the Billing Supervisor.  If the telephone message was clear, the Billing staff member may IM the Billing Supervisor, who will take the above "Billing Supervisor Action".

3. Patient emails the request to Billing.

The Billing staff member de-identifies the patient and any PHI and forwards the email to the Billing Supervisor.  The Billing Supervisor will follow the above "Billing Supervisor Action".  Billing Supervisor may have Biller send decision securely to student.

Reversals

If a reversal of fees is authorized, the manager will securely contact the Billing staff member and document the authorization to reverse fees with the amount, date and manager signature (or document via IM) and is noted in the ticket notes.

If situation escalated and actions were taken, the Billing staff will add an administrative note in "Registration" with the date, the situation and action, the manager approver and the Billing staff initials.

 

OPTOMETRY SERVICES *

Effective Date: 
Tue, 10/28/2014
Reviewed: 
Thu, 03/22/2018
Revised: 
Mon, 02/29/2016
Policy: 

The UCSC Student Health Services (SHS) provides Optometry Services through a collaboration with the UC Berkeley School of Optometry (UCBSO).
Services are provided by a licensed faculty optometrists in accordance with all laws, regulations and ethics pertaining to optometry.

The UCSC SHS Optometry Department also serves as a training site for 4th year UCBSO student optometrists, who provide exams and eye care services under the supervision of the faculty optometrist.

Procedure: 

Optometry Services from the UC Berkeley School of Optometry includes the following and will be provided by faculty optometrists and/or 4th year UCB student optometrists, under the supervision of the faculty optometrists, who document those services in the UCSC SHS electronic medical record:

  • Optometric exams for eye health screenings and vision care
  • Evaluation of ocular health, and referral to specialist as needed
  • Optometry Technician services
  • Prescriptions for glasses and contact lenses
  • Acquisition of glasses and contact lenses pursuant to prescriptions (from in-house or outside)
    - frames available on-site
  • Fittings for glasses and contact lenses
  • Submission of optometric claims to Vision Insurance providers

Additionally, the optometrist may see patients from the UCSC SHS Same Day Clinic, who present with urgent eye illnesses or injuries for the diagnosis and management of eye emergencies.

PHARMACIST DISPENSING OF EMERGENCY CONTRACEPTION, NICOTINE REPLACEMENT PRODUCTS AND NALOXONE UNDER PRESCRIPTION *

Effective Date: 
Thu, 09/25/2014
Revised: 
Mon, 04/12/2021
Policy: 

Effective January 1, 2014, licensed pharmacists in the state of California have been given provider status under a bill signed by the Governor on October 1, 2013.  This bill, SB 493, allows pharmacists certain authorities in all practice settings, to include the following:

"The bill would authorize pharmacists to perform other functions, including, among other things, to furnish self-administered hormonal contraceptives, nicotine replacement products, and prescription medications not requiring a diagnosis that are recommended for international travelers, as specified."

The pharmacy also prescribes epinephrine to authorized first responders and trained lay rescuers under a UCSC SHS protocol.

Procedure: 

The UCSC Pharmacy follows all applicable pharmacy laws and regulations.

EMERGENCY CONTRACEPTION

The California State Board of Pharmacy has an established protocol in place for Pharmacists Furnishing Emergency Contraception.

Section 4052.3(a)(2) of the California Business and Professions Code authorizes a pharmacist to furnish emergency contraception pursuant to a protocol approved by the California State Board of Pharmacy and the Medical Board of California.  Use of this protocol satisfies that requirement: California Code of Regulations Title 16 ~ 1746. Emergency Contraception and is followed by UCSC SHS Pharmacists.  This protocol can be found in the UCSC SHS Pharmacy Compliance Manual for the State Board of Pharmacy.

The UCSC Pharmacy only uses the one tablet option for EC, either levonorgestrel or ulipristal.

 

NICOTINE REPLACEMENT PRODUCTS

The authority to furnish prescription nicotine replacement products for smoking cessation is pursuant to a statewide protocol if certain training, certification, recordkeeeping, and notification requirements are met.  Once a statewide protocol is developed by the California Board of Pharmacy and the Medical Board of California, it will automatically apply to all pharmacists and will be incorporatied by the UCSC SHS Pharmacy.  The protocol currently includes the following:

Allows a pharmacist to furnish nicotine replacement products in accordance with a state treatment prococol, provided:

1. Records are retained of drugs and devices furnished for at least 3 years so as to notify health providers or permit monitoring of the patient

2. The pharmacist notifies the patient's primary care provider of drugs and devices furnished or into a patient record

3. The pharmacist must complete 1 hour of CE on smoking cessation therapy

- See additional information below.

 

NALOXONE

The authority to furnish prescription naloxone for opioid reversal is pursuant to a statewide protocol if certain training, certification, recordkeeeping, and notification requirements are met.  Once a statewide protocol is developed by the California Board of Pharmacy and the Medical Board of California, it will automatically apply to all pharmacists and will be incorporatied by the UCSC SHS Pharmacy.  The protocol §1746.3 Protocol for Pharmacists Furnishing Naloxone Hydrochloride, currently includes the following:

Allows a pharmacist to furnish naloxone in accordance with a state treatment prococol, provided:

1. Records are retained of drugs and devices furnished for at least 3 years so as to notify health providers or permit monitoring of the patient

2. The pharmacist notifies the patient's primary care provider of drugs and devices furnished or into a patient record and/or documents the process in the electronic medical record.

3. The pharmacist must complete 1 hour of CE on naloxone.

Until such time as the California Board of Pharmacy and the Medical Board of California formalize the protocol, the UCSC SHS Pharmacists, acting as delegate for the Medical Director, will act under an internal protocol adapted from the protocol currently under consideration from the California State Board of Pharmacy and the Medical Board of California.  This protocol can be found in the UCSC SHS Pharmacy Compliance Manual for the State Board of Pharmacy.

 

EPINEPHRINE

The California State Board of Pharmacy has approved regulation 4119.3 for pharmacists to furnish, without a prescription, epinephrine to first responders and trained lay rescuers for the purpose of rendering emergency care in accordance with Section 1797.197a of the Health and Safety Code, if both of the following requirements are met.

Under UCSC Protocol, pharmacists will write prescriptions, under the auspices of the UCSC Student Health Center Medical Director, for the official campus community members who can provide a current certificate demonstrating that the person is trained and qualified.  The recipient will be charged full price for the product which can be paid by Recharge Form.

The pharmacy will also include a log for documenting a record that must be kept for 5 years with pertinent information (see below).

 

NICOTINE REPLACEMENT PROTOCOL

Effective January 1, 2014, licensed pharmacists in the state of California have been given provider status under a bill signed by the Governor on October 1, 2013.  This bill, SB 493, allows pharmacists certain authorities in all practice setting, to include the following:

B.2.

An established process for informing the patient of the status of the health care professional and obtaining patient consent for such person's participation in or observation of the patient's care.

Notes: 
P&P

B.1.

A definition close and adequate supervision of students and postgraduate trainees.

Notes: 
P&P

Z.

The organization follows established protocols for instructing patients in self-care after surgery and provides written instructions to patients.

Notes: 
P&P

Y.

The organization has written guidelines for internal transfer of care from one provider to another. These guidelines address:

1. Information to be transferred about a patient’s care, including treatment/ services, current condition, and any recent or anticipated changes.

2. How the information will be communicated among members of the health care team.

Notes: 
n/a

N.13.

Fire risks are identified and minimized, and staff members are prepared to address fire hazards, if necessary.

Notes: 
P&P

B.4.b.

A method of identifying designated locations of paper records throughout the organization in order to deter unauthorized access.

Notes: 
Medical Records
Policy: 
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