Insurance: Other
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Third Party Insurance and Access to Care
In Summer 2024, Student Health and Well-Being (SHW) launched a new initiative to expand access to care for students without UC SHIP and reduce out-of-pocket costs for students and their families. In Phase 1 of the project, SHW implemented billing for UnitedHealthcare PPO plan.
Effective September 21, 2026, Student Health Services (SHS) will accept and directly bill Aetna, Anthem, Blue Shield, Cigna and UC Care PPO plans for eligible services.This change makes it easier for eligible students to receive care at SHW by allowing SHW Insurance to bill participating insurance plans directly, reducing the need for upfront payments and reimbursement requests.
What this means for you:
- If you are enrolled in one of the eligible PPO plans, the clinic can submit claims directly to your insurance, and you may utilize SHS for your primary care needs.
- You may be responsible for any applicable copays, coinsurance, or deductibles, based on your specific plan benefits.
Important notes:
- Coverage and payment are subject to your individual plan’s terms and conditions. To confirm your plan's benefits, please contact your insurance provider directly.
- Please bring your insurance card to your appointment and verify your coverage in advance.
Eligible Plans
Aetna
Eligible plans:
- Aetna Select Open Access PPO
- Aetna Open Choice PPO
To confirm your plan's benefits, please contact your insurance provider directly.
Anthem Blue Cross
Eligible plans:
- Prudent Buyer PPO
- Anthem Blue Cross EPO on and off the Exchange/Covered CA (Pathway X or Pathway Tiered — All metal levels.)
- Anthem Blue Cross PPO through Employer Groups*
- Anthem Blue Cross products not listed above*
- Blue Cross/Blue Shield (out of state)*
- Blue Cross Blue Shield Federal Employee Program
Blue Shield
Eligible plans:
- Blue Shield of CA PPO through Employer Groups*
- Blue Shield IFP on and off the Exchange/Covered CA
- Blue Shield SHOP PPO on and off the Exchange/Covered CA (Bronze Level Only)
- Blue Shield of CA products not listed above*
Cigna
Eligible plans:
- CIGNA Open Access PPO
- CIGNA Open Access Plus
- CIGNA + Oscar (C+O) Open Access Plus PPO
To confirm your plan's benefits, please contact your insurance provider directly.
UC Care
Eligible plans:
- UC Care
To confirm your plan's benefits, please contact your insurance provider directly.
UnitedHealthcare
Eligible plans:
- UHC Select/Select Plus
- UHC Choice PPO
- UHC Choice Plus PPO
- United Qualcomm — Premier PPO and QDHP*
- UHC products not listed above
*Not all plans are the same. Although UC San Diego is contracted with the insurance company, SHS may not be in-network for every plan they offer. To avoid unexpected costs, check with your insurance company to confirm that SHS is in-network under your specific benefit plan.
Frequently Asked Questions
What insurance plans are included in this change?
This update applies only to Aetna, Anthem, Blue Shield, Cigna, UC Care or UnitedHealthcare PPO plans. Other plans such as HMO or EPO plans are not included at this time.
When does direct billing begin?
Direct billing for the Aetna, Anthem, Blue Shield, Cigna, UC Care or UnitedHealthcare PPO plan begins on September 21, 2026. Services provided before this date are not eligible for direct billing.
Will I still have to pay anything at the time of my visit?
Possibly. You may be responsible for copays, coinsurance, deductibles, or non-covered services, depending on your specific insurance plan.
Do I need to do anything before my appointment?
Please bring your insurance card to your appointment. We also recommend confirming your benefits directly with your insurance provider prior to your visit.
What if I already paid out-of-pocket for a visit after September 21, 2026?
Our clinic contract to bill your insurance company is effective 9/21/2026. Any services obtained prior to this date for payment would need to be requested by the patient. We are happy to provide an itemized statement that you can use to request reimbursement from your insurance. Please contact UC San Diego Student Health Insurance at 858-249-4250 or email us at SHIP3@ucsd.edu to request a statement or ask any questions. Please work with your health plan to see what is required for reimbursement. Contact the member services phone line on the back of your insurance card to start the reimbursement process.
Will all services at Student Health Services be covered?
Coverage is determined by your insurance plan. Some services may not be covered or may require prior authorization. The clinic can submit claims, but coverage is not guaranteed. We recommend confirming your benefits directly with your insurance provider prior to your visit. To assist you with reducing out-of-pocket expenses, please consider the Reduced Access Fee for Tritons (RAFT) Bridge Program.
Who can I contact if I have questions?
For billing or clinic-related questions, please contact Student Health Services at 858-249-4250. For more detailed benefit information, contact the insurance provider directly using the member services phone number on your insurance card.
I opted into a Reduced Access for Tritons (RAFT) membership. Will this change my RAFT pricing or benefits?
No, if you enrolled in a RAFT membership, Student Health Services will continue to honor your RAFT membership and pricing for the 2026-2027 academic year, regardless of this new direct billing option.
Can I cancel my RAFT enrollment if I have an eligible PPO plan?
If you would like to discuss canceling your RAFT enrollment, please contact Student Health Services as soon as possible at 858-249-4250 or email SHIP3@ucsd.edu.