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UCSC Student Insurance Office

To: UCSC Students

From: UCSC Student Insurance Office

November 09, 2011

Please disregard this notice if you have already successfully waived the UCSC sponsored health insurance plan for fall quarter 2011-12.

To opt out of the UC Student Health Insurance Plan (UC SHIP) for winter quarter 2012 and the remainder of the academic year 2011-2012, students must complete the on-line insurance waiver.  The deadline for waiving out for winter quarter 2012 is December 1, 2011.

Important note: Once accepted, the waiver is in effect for the current quarter and the remainder of the academic year. A new waiver must be submitted at the beginning of each academic year.

To waive the UC SHIP plan, follow the link to the secure on-line waiver site:

https://studentinsurance.wellsfargo.com/~ucsc

On-Line Waiver Questions

These are the questions you will be asked in our on-line waiver process.  Please have your insurance information available before you log-on to the on-line waiver site.  When you are ready to go on-line to waive, please remember to print a page of the waiver acceptance/denial page. The Student Health Insurance Office will not accept waivers past the posted deadlines and does not accept waivers in paper format.

Health Insurance Information (complete if waiving UC SHIP undergraduate or graduate medical coverage)

- Name of Insurance Company:
- Insurance Company Phone #:
- What is the subscriber's name for this coverage
- Insurance Group #:
- Insurance Subscriber ID#:
- What is the subscriber's relationship to you?

Coverage Information

1. Is your insurance plan owned, headquartered and operated in the United States? Yes/No
2. Does your plan provide primary care services within 50 miles of UCSC? Yes/No
3. Does your plan provide emergency care with a 30 mile radius of UCSC? Yes/No
4. Does your plan have inpatient and outpatient mental health benefits? Yes/No
5. What is your plan's deductible per individual each year? (This refers to any amount that you must pay first before you plan will reimburse a doctor's visit)
6. What is your plan's maximum out-of-pocket expense per individual each year? (This refers to the maximum dollar amount you are ultimately responsible for)
7. What is your plan's maximum lifetime benefit? (This refers to the maximum amount that your plan will pay out on your behalf for health care costs)

Enroll in CruzCare?  Yes or No

For students waiving the university sponsored health insurance UCSC offers CruzCare, an inexpensive pre-paid access plan for busy students seeking on-campus health care.  CruzCare provides unlimited Student Health Center visits for care of illness or injury, including Health Center lab and X-ray.  Enrollment in CruzCare is part of the on-line waiver process.  Detailed information including coverage and cost will be available on the waiver site and can be found on the Student Health Center website at http://healthcenter.ucsc.edu/billing/insurance.shtml
 
If you need help, please contact the Student Health Insurance Office at (831) 459-2389 or by email at insure@ucsc.edu.