Insurance Deadline 9/1/12

To: UCSC Students

From: UCSC Student Insurance Office

To opt out of the UC Student Health Insurance Plan (UC SHIP) for fall quarter 2012 and the remainder of the academic year 2012-2013, students must complete the on-line insurance waiver.  The deadline for waiving out for fall quarter 2012 is September 1, 2012.

Important note: Once accepted, the waiver is in effect for the current quarter and the remained 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:

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 online 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 USHIP or GSHIP medical coverage)

-Insurance Company Name:
-Phone #:
-Member ID #:
-Group #:
-Subscriber Name:
-How long have you been covered under your current health insurance plan?

Coverage Information

1. Does your plan cover hospital stays for medical, surgical, and mental health care services? Yes/No
2. Does your plan cover doctor visits for medical and mental health conditions? Yes/No
3. Does your plan cover medications prescribed by a doctor? Yes/No
4. Does your plan cover medical services related to injury or illness caused by alcohol or drug use? Yes/No
5. Does your plan cover medical services related to injury from participation in all types of recreational or amateur sports? Yes/No
6. Does your plan have a Lifetime Maximum benefit? (Indicate amount) $
7. Does your plan have an Annual Maximum benefit? (Indicate amount) $
8. Does your plan have a Per Injury or Illness Maximum benefit? (Indicate amount) $
9. What is your health planís Annual Deductible for an individual? (Indicate amount) $


10. Are you an international student? Yes/No
11. Does your plan have a claims payment office in the United States? Yes/No
12. Does your medical insurance company have a policy written in English with benefits expressed in US dollars ? Yes/No
13. Does your plan pay at least $10,000 for Medical Evacuation benefit? Yes/No
14. Does your plan pay at least $7,500 for Repatriation of Remains? Yes/No

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

For more detailed information regarding CruzCare visit Scroll to the bottom to Prepaid Access to the Student Health Center.

If you need help, please contact the Student Health Insurance Office at (831) 459-2389 or by email at