Student Health Insurance - Outpatient Mental Health Benefits

Enrolled medical students may see mental health providers outside of UCSF and are covered by the benefits outline below. If a student has another insurance plan, that plan is charged first and student health insurance is secondary. Students are advised to call the insurance company prior to starting care to confirm benefits and understand their financial responsibility. All care must be pre-authorized and have a referral from Well-Being or Student Health Services. If students are referred by the Well-Being Program, our staff will inform Student Health Services of the mental health referral for them to enter the referral into the computer system and activate reimbursements.

Send claims to:
Personal Insurance Administrators, Inc.
P.O. Box 6040
Agoura Hills, CA 91376-6040
1-800-468-4343

Student Health Insurance is underwritten by:
Nationwide Life Insurance Company
Policy Number 302-078-0406

Individual mental health providers may collect full payment from students at the time of service and then students are responsible for submitting their own claims for reimbursement. Some providers will charge students a co-pay and then bill the insurance company directly. There is no requirement that a provider be a part of the network. Any licensed mental health provider is eligible for appropriate reimbursement.

Students have a $250 deductible that must be met before reimbursement can begin. After the deductible is met, reimbursements will begin using the following criteria:

Individual Outpatient (non-parity diagnosis):
80% of reasonable and customary rate (R&C)*; limited to one (1) doctor’s visit per week, up to a maximum of 40 visits per policy year.

Individual Outpatient (parity diagnosis):
90% of R&C. The following are considered parity diagnoses: 1) schizophrenia; 2) schizo-affective disorder; 3) bipolar disorder (manic-depressive illness); 4) major depressive disorders; 5) panic disorder; 6) obsessive-compulsive disorder; 7) anorexia nervosa; and 8) bulimia nervosa.

Couples Therapy:
Couples treatment may be billed for reimbursement as long as one of the students is insured. Reimbursement is based on the enrolled student’s parity or non-parity diagnosis.

*R&C rate is determined by a governmental agency and is deemed “proprietary information” which is not released by the insurance company. Please note that in most cases R&C will be less than the rate charged by the therapist.