How UC Berkeley students can navigate health care insurance changes

Tang Center with sign that reads New Insurance Carrier
Chi Park/Staff

In March, the campus announced it was transitioning the Student Health Insurance Plan, or SHIP, to a new insurance carrier, effective Aug. 1. We are excited that our new carrier has the ability to customize its services to the needs of UC Berkeley students and brings technological innovations to the plan. We believe these changes will ultimately improve students’ access to coordinated care.

Unfortunately, some benefit changes were necessary to prevent further premium increases. We understand that any time there is a change, it can cause confusion and, occasionally, panic for plan members and the community. We hope to explain some of the changes and their impacts as well as provide information on resources and options available to students on SHIP to help ease the transition.

The unfortunate reality is that SHIP claims — aka use and cost to the plan — have increased annually for the last three years. The result of those rising claim costs is that SHIP premiums have to increase to account for them. This reality was evident throughout all the health insurance bids the campus received.

While we heard from student leaders that they preferred to see costs increase on the premium side because they felt more predictable and budgetable, as fiduciary agents of the plan, we have to find a balance between premium increases and membership. Put plainly, if SHIP loses members because of steep premium increases, the people left on the plan, especially if they are those who need health insurance, will continue to face higher premiums.

At the same time, we absolutely want to keep out-of-pocket fees affordable when students need to access care. We have heard concerns from some students, especially those with chronic conditions, that the benefit changes that were made — a $10 increase in specialty copays and a $150 increase in the emergency room, in particular — feel steep. These benefit changes, while not financially insignificant for the members who will experience them, allowed SHIP to keep the premium increase from escalating even higher and are still in line with comprehensive plans on the insurance market.

University Health Services, along with our partners in the UC Berkeley Division of Equity & Inclusion and other parts of campus, are exploring financial and care management options for students with chronic conditions who may need additional assistance in light of these changes. Additionally, for all SHIP members, we have established resources that can supplement or provide alternatives to emergency room care.

Currently, these include a 24/7 nurse line, reduced urgent care copays and telemedicine options that allow direct access to doctors and mental health providers when the Tang Center is closed. It is also important to understand what is not changing: primary care copays, urgent care copays, pharmacy copays, mental health copays (including psychiatry), deductibles (which only apply outside of the Tang Center) and out-of-pocket maximums.

Any time a plan changes carriers, there is an anticipated impact on the network of providers. But our analysis of the medical network offered by our new partners has found the network to be as comprehensive as what is currently provided by SHIP.

If a student is currently in treatment with a clinician or hospital that is found to be out of network when we make the transition, there are several options available. These options include bringing the provider into the network, creating single case agreements that allow in-network pricing for the student, or transition-of-care assistance.

If the network is devoid of a particular specialty area, the SHIP office can advocate for honoring the in-network cost-sharing for the member. To explore options and make arrangements, it is critical for members to contact the SHIP office early in the transition — i.e. before Aug. 1. The SHIP website has a medical provider search tool for those who wish to look up their current providers, or they may contact the SHIP office, where case coordinators are ready to assist them.

Mental health seems to be the topic that has generated the most confusion and anxiety throughout this transition process. There is always a disruption to the network of mental health providers when a carrier changes. We have heard concerns from mental health providers regarding reimbursement rates and utilization control concerns regarding the new network carrier.

In anticipation of these concerns, we worked with our new carrier to create a custom mental health network just for UC Berkeley SHIP that offers a custom fee schedule — aka how much they get paid — that is on par with what providers currently receive from SHIP and reduces administrative and billing barriers. Our intention in offering this custom arrangement is to allow SHIP students to continue to see their existing mental health providers without disruption.

We are currently developing a provider search tool for this custom network. In the meantime, to find out the network status of mental health providers or if students hear concerns from their providers, students should contact the SHIP office for assistance and options. Contracting with providers can take time, so we have started this process early and are on track for having a robust mental health network for the fall.

The tricky part of running a large insurance plan is finding a way to offer students and their families a vast network with comprehensive benefits without escalating costs more than necessary each year. SHIP remains a comprehensive plan that is competitive with what is available in the marketplace and at similarly situated peer institutions.

We absolutely want to hear from any students and providers who have outstanding concerns about the transition, their provider options and their ongoing care. The SHIP office can be reached via email at [email protected], through eTang messaging, by phone at 510-642-5700 or in person at the Tang Center. We, along with the carrier, will also be available after hours Tuesday, April 30 from 5 to 6:30 p.m. on the first floor of the Tang Center for those who have questions or want additional information about the transition and resources available.

Guy Nicolette is the Assistant Vice Chancellor for University Health Services.