Frequently Asked Questions About GSHIP

1. When should I expect to receive my insurance cards from Student Resources proving that I am covered for medical care?
2. Do I have to see a provider at UCI's Gottschalk Medical Plaza or through the UCI Health System?
3. What do I need to do in order to see a specialist?
4. Am I allowed to have a second opinion?
5. I have a question about my bill - who do I contact?
6. Is dependent insurance available through GSHIP?
7. I am a GSHIP member and I am pregnant. Are maternity services covered under GSHIP, and will my baby be covered after birth?
8. Are immunizations covered through GSHIP?
9. Is Physical Therapy covered under GSHIP?

1. How do I reach Western Dental Services, INC. Member Services?
2. I lost my I. D. card. How do I get a new one?
3. How do I receive benefits under my dental plan?
4. How do I change my dental provider?
5. How long do I have to wait to get an appointment with my dentist?
6. What is the procedure for emergency dental visits?

1. How can I get a refill on my contact lenses?
2. Can I get my eyes examined other than between the hours of 9 a.m. and 5 p.m., Monday through Friday?
3. If I feel I have a medical condition related to my eyes, where do I go?

Your proof of insurance card is not issued to students until AFTER they have paid their fees to the UCI Cashier and enrolled in classes. Payment of fees is the only certain means by which UCI knows a student will be enrolling in GSHIP. Once your full fees are paid, two steps subsequently take place. First, Mary Jo Gallegos (UCI's GSHIP Coordinator) forwards to Student Resources an electronic listing of those students who have enrolled and paid their fees. She forwards this listing weekly starting in early September. This first step can take 1 - 5 workdays. Second, Student Resources needs 3-4 workdays to process the new student listing they receive from UCI and then disseminate the relevant information, including proof of service cards, directly to students at their campus address on file with the Registrar's Office. Overall, from the time a student's fees are paid by either the student or their department, it may take approximately 8 - 15 days before an insurance card is physically delivered to them. While many students receive a packet of information in August regarding GSHIP; the actual medical insurance card is not enclosed in that packet because fees have not been paid at that time. Pay your fees early.

Having said this, once a student's fees are paid, they are technically covered and can receive medical care. Thus, should something urgent arise, students may still contact Mary Jo Gallegos at (824-2388) directly to arrange for care.

Understand that while you should have received a packet of information regarding GSHIP over the summer; the card was not enclosed because fees had not been paid at that time. Also, if are not receiving insurance information, please check to make sure that your address on file with the UCI Registrar is up-to-date. Otherwise, mailed materials may not reach you.

NO. However, in order to be covered at 90%, you must see a provider that is contracted with Student Resources. All UCI Medical Group physicians are contracted with Student Resources. Other community physicians may or may not be, so be sure to ask them. If you wish to see a provider who is not contracted with Student Resources, you may do so, however you will only be covered/reimbursed at 50% of the usual and customary fee. If you choose to see a provider who is outside the UCI Medical Group, you must contact UCI's GSHIP insurance coordinator, Mary Jo Gallegos at (949) 824-2388 for an authorization form.

Your Primary Care Physician (PCP) MUST refer you to a specialist (Well Woman Care visits to a gynecologist are the only exception). Please contact Mary Jo Gallegos when you have a written referral from your PCP for the appropriate referral paperwork.

YES, you are allowed one second medical opinion per year covered at 90%, provided that you see a physician contracted with Student Resources.

You should first contact Student Resources with any questions about billings or claims. They can be reached via their website or by phone at: 1-888-344-6098 [UCI Policy No. 2007-977-1]. If you need additional assistance, then you may contact UCI's GSHIP insurance coordinator, Mary Jo Gallegos, at (949) 824-2388, for other questions.

NO. Dependent insurance is not available under UCI's GSHIP plan. However, if you are interested in obtaining coverage for a dependent family member, you should visit our Health Coverage for your Dependent web site.

Historically, UCI has twice implemented graduate student dependent plans. The plans were guaranteed issue without disclosure of individual medical history, meaning the dependent could not be denied coverage. The resulting claims to premiums ratios were excessive and the insurance companies refused to continue a plan that was losing so much money. Therefore, both times the insurance carrier declined to renew the plan because UCI could not make dependent coverage mandatory.

YES. Maternity is 90% covered. A child born to a covered person shall be covered for Accident, Sickness, and Congenital Defect for the first 31 days of life from the date of birth. Please contact UCI's GSHIP insurance coordinator, Mary Jo Gallegos at (949) 824-2388 for specific information about baby coverage.

YES, some are. The following immunizations ARE covered through GSHIP (to 90% of the negotiated charge under preferred care or 50% of the reasonable and customary charge non-preferred care): Hepatitis A & B, MMR (Measles, Mumps, Rubella), Polio vaccine and PPD Tuberculin test (not an "immunization", but still covered). The following immunizations ARE NOT covered, but are available to you for a reasonable fee at the Gottschalk Medical Plaza: Diphtheria, Tetanus, Varicella vaccine (chicken pox), injectable Typhoid, Typhus, and Cholera and the flu vaccine. The GSHIP immunization benefit does not provide coverage for the physician office visit component. [More...]

YES. When ordered by your PCP, physical therapy benefits are covered at 90% of the negotiated charge under preferred care or 50% of the reasonable and customary charge for non-preferred care per visit , to a maximum of $2,000 per condition, per plan year.

Western Dental Services, Inc. Customer Service Help Line can be reached at
1-800-672-6283.

Call Western Dental Customer Service Help Line at 1-800-672-6283.

It is an HMO type plan, so it is important that you see your Primary Care Dentist for any dental work that needs to be done.

To expedite assignments, all GSHIP participants will initially be assigned a Primary Care Dentist at the Costa Mesa Western Dental Center (949) 645-0218. To change your Primary Care Dentist you may call Western Dental Member Services at (800) 672-6283.

This depends upon appointment availability at your assigned dental office. In most situations you should be able to schedule a routine dental appointment (unless you are requesting a specific time or day of the week) within one to two weeks. Emergency visits should be scheduled within 24 hours.

In the event you require emergency dental care, contact your Primary Care Dentist (PCD) to schedule an immediate appointment. For dental emergencies that occur after-hours or on weekends, please contact your PCD for instructions on how to proceed. If your PCD advises you that they are not available, you may obtain emergency services from any licensed dental provider. You must file a claim form to receive reimbursement for any out-of-pocket expenses incurred in an emergency. Emergency benefits are subject to the same copayments as your dental plan. Please refer to your Evidence of Coverage (EOC) booklet for full plan details.

A. The best way is to make an appointment at UCI's Student Health. Please either bring or wear your contact lenses, if applicable, so that the prescription strength and fit can be checked. In most cases, your lens strength will be in stock and will be dispensed during your appointment.

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B. Call (949) 824-5939 and mention you cannot make it in for an appointment but would like more contacts. The office will pull your chart, call you back, and give you the following options:

1. Pay for a supply via credit card and either pick them up at UCI or have it mailed directly to your home.
2. Pick up a spare pair from the clinic to hold you until you can make an appointment.

YES. You can now get your eyes examined by Orange County Optometric Group outside of normal business hours by calling (714) 776-2020 for an appointment. State that you have GSHIP insurance through UCI and request driving directions to the off-campus office. Evening and weekend appointments are available. The drive to Dr. Occhipinti's off-campus office is approximately a half hour from UCI, or fifteen minutes from the UCI Medical Center.

You can call the UCI's Student Health Center for an eye appointment. If it is an emergency, ask to be seen that day.

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You can call the Gottschalk Medical Plaza ophthalmology department at (949) 824-2020, or call Mary Jo Gallegos at (949) 824-2388. In a serious emergency, dial 911.