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.