Student Health Insurance

Touro University California (TUC) is concerned for the health and welfare of its students therefore, TUC mandates participation in the Touro University Student Health Insurance Plan (SHIP), unless the student is approved to be waived out of the program. Student wishing to apply to waive the SHIP must have health insurance that meets the specified waiver criteria.

By enrolling in TUC, students acknowledge that they are required to have medical insurance at all times during their enrollment. They further acknowledge that if they do not have a plan that meets or exceeds the defined standards of the insurance plan offered through TUC, they will be responsible for paying for the TUC student group insurance plan either personally or through financial assistance funds.  Details of the Touro University Student Health Insurance Plan coverage and costs, as well as information on the waiver procedures, are provided to students in the information below.

Using the Student Health Insurance Plan

Below is a brief guide to using the Student Health Insurance Plan(SHIP), Dental Plan and Vision Plan. This webpage is brought to you by Student Services, the Student Health Council and the SGA VP of Student Insurance to help you navigate the SHIP and other health resources available to you as a Touro student. Please take a few minutes to read through this information.

If you did not waive out of the student health plan, you are automatically enrolled if you are taking at least 6 units and a card will be mailed to you at the address you have on file with the Registrar. If you do not receive a card or need to print one you can do it from the link below. To opt out of the SHIP you must submit a waiver at the beginning of each plan year.

Main menu

General information

Plan brochures

Waiving out of SHIP

Temporary ID card

 Affordable Care Act (Obamacare) FAQs

SHIP for dependence

Provider search

Prescription

Claim procedure

Dental & Vision plan

Other useful information

SHIP powerpoint presentation

General information

Key players involved:

Ascension is our plan broker; they work with us to help us get the best rates on our plan.

Nationwide is our health insurance company; they receive the premiums (This year we got quotes from all the major players, and Nationwide was the best option.)

PIA (claims administrator) manages the money by reviewing provider claims and making payments for health services on your behalf. This is the company you will work with directly. They will send you mail and you should respond or otherwise notify them of services you have or have not received.

Anthem Blue Cross is our dental insurance plan provider. They offer three options for us to choose from this year. It is separate from the SHIP premium so you will need to sign-up individually if you are interested. They offer several payment options.

VSP is our vision plan, also optional, so you will need to sign up individually and make the payments yourself. The program is 12 months and starts when you sign-up.

SmileSaver is a dental discount plan. It is not an insurance plan, but it might be worth comparing to the Anthem plan to see what fits you best.

For information about the Student Health Insurance Plan (SHIP) go here: Touro University California Website at Ascension (scroll down on this site to find dental and vision plans).

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 Plan brochures

      Plan Snapshot

      Plan Summary

      2015-2016 Student Health Insurance Plan Brochure

 To access brochures for prior year please see links below:

       2014-2015 Student Health Insurance Plan Brochure- This plan is in effect until 8/1/2015 for COM and COP classes of 2018

       2013-2014 Student Health Insurance Plan Brochure

2012-2013 Student Health Insurance Plan Brochure 

2011-2012 Student Health Insurance Plan Brochure

Summary of Benefits and Coverage (SBC)

The Affordable Care Act regulations require that all insurance companies provide information for their plans on a standardized template.  The format is mandated and cannot be changed, so that a person can compare SBCs from different plans or different companies on a line-by-line basis.  For example, if a student/parent were comparing an employer-based plan to this SHIP plan, each insurance company would provide the same standardized template for easier reference.  It must also include a cost calculation example (page 7) which is unique to your plan’s benefits.  The “amount owed to providers” of $7,540 and $5,400 are the same for all SBC cost calculations.  The “plan pays” and “patient pays” amounts are unique to your plan’s benefits.

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Waiving out of SHIP

Click here for Waiver FAQ

To waive out of the SHIP please complete this form:

Student Health Online Waiver Application

Waiver Application Deadlines

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Temporary ID card

If you need an ID Card please use this link: Insurance ID card

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SHIP for dependence

This option has been discontinued beginning with the June 1, 2014 term.

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Provider search

To find a provider within the SHIP network go to the Cigna Network provider search page here:

Cigna Provider Search Engine 

  • In effect as of June 1, 2013 for all other classes and programs

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Prescription

Our prescription discount program is Express Scripts. They are accepted at most major pharmacies. To find a pharmacy near you or order online please visit them online or call them.

Express Scripts, Inc.

1-800-447-9638

www.express-scripts.com

Available 24/7/365

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Claim procedure

 If you have received a bill or paid for services that are covered by the plan please complete the claims procedure below.

Please note: For all classes the Claims Administrator has changed to PIA. Make sure your doctor has the updated information, available on your ID card.

CLAIM PROCEDURE in the event of Injury or Sickness:

  1. Go to the nearest PPO Doctor’s office, urgent care, or Hospital. While you may choose any Doctor or Hospital, using the providers available through the PPO network may greatly decrease your costs. For a complete listing of the PPO Doctor or Hospital facilities, visit www.Cigna.com or call 1-800-325-1404.
  2. If you go to a Doctor’s office or to the Hospital, be sure to bring your insurance identification card. If the Doctor or Hospital needs to verify your coverage, they may call Personal Insurance Administrators, Inc., at 1-877-358-3727. Carry your insurance ID card with you at all times.
  3. After you receive treatment, your provider will submit a claim to the insurance company. Providers should submit claims electronically to PAYER ID 62308 or mail to Cigna at the following address:
        
       
    Cigna Healthcare
        P.O. Box 188061
        Chattanooga, TN 37422-8061

  4. In some circumstances, such as using a non-PPO provider, you may be asked to pay up-front. In this case, submit a claim for reimbursement for the portion of the charges the company is responsible for paying by sending all itemized Hospital and medical bills along with either a copy of your health insurance ID card or a completed claim form* to: 
      
       Personal Insurance Administrators, Inc. 
       P.O. Box 6040 
       Agoura Hills, CA 91376-6040


    *Note: Claim forms are not required but may help to expedite payment of your claim
     
  5. If you have questions about the status of your claim after it has been submitted, please call Personal Insurance Administrators, Inc., at 1-877-358-3727, Monday–Friday, 8:00 a.m. to 5:00 p.m. (4:00 p.m. on Fridays) PT.

The completed claim, including all Hospital and medical bills, must be submitted for payment within 90 days after the date loss occurs, or as soon thereafter as is reasonably possible.

You have the right to request an independent medical review if health care services have been improperly denied, modified, or delayed based on medical necessity. If you believe a covered item has been denied please contact the Student Health Council or the VP of Student Health Insurance.

Always keep a copy of all documents submitted for claims.

Special Note: Claims must be submitted within 90 days after an injury or sickness has occurred in order for the claim to be paid.

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Dental & Vision plan

Dental Discount Plan Program

A number of dental plans are available this year. The links below will take you to pages for the three major coverage options: Anthem Blue Cross, Ameritas, and SmileSaver. Each plan has individual options as well.

To access information on the three plans available through Anthem Blue Cross, go here and scroll to the bottom of the page for this year's plan: Touro University California Website

For dental plans available through Ameritas please click here: Ameritas Dental Plans

For the SafeGuard SmileSaver Discount plan follow this link: SmileSaver Dental/Vision Plan

Optional Vision Plan

This year we have a vision plan available to students through VSP. To enroll in the plan please follow instructions found at this link:VSP

If you have any problems with your vision plan coverage please notify the Student Health Council or the SGA VP of Insurance and follow the instructions for submitting a grievance with VSP at this link: VSP Grievance System

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Other useful information

The Student Health Clinic offers many services without a deductible. For a list of available services and information on accessing your immunization record through e-value please visit the Student Health Clinic website at:

http://studentservices.tu.edu/studenthealth/index.html

Each year the Student Health Council and the SGA VP of Student Insurance work hard to provide the best possible options for students. It is important that you do research to determine what fits your needs and notify us if things do not seem to be going the way you thought they would. As health profession students you are very busy and we are here to help. Please contact us if you have any questions.

Best Regards,

The Student Health Council and SGA VP of Student Health

(contact information available on www.tustudentlife.com)

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SHIP powerpoint presentation

click here to download

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