Frequently Asked Insurance Questions

University Health Services (UHS) provides students with many basic health care services at no extra cost, including medical care and mental health counseling and psychiatry. UHS also has clinics for women's health, STI testing and treatment, and allergy/immunization. UHS coverage complements, but does not replace, health insurance covered services.

SHIP is a comprehensive insurance plan for UW-Madison students, which covers additional health care costs incurred both at UHS and elsewhere. This includes travel and meningococcal vaccines, the HPV vaccine, and a contraceptive benefit at UHS, as well as after hours, emergency room, hospitalization, and other specialized medical services locally and nationwide.

I am young and healthy; why do I need health insurance?

Although students have access to UHS, this is not a substitute for health insurance. UHS is not open during evenings and weekends and does not provide emergency care. UHS does not provide diagnostic testing such as MRI’s or CTs, specialists’ visits and procedures, or hospitalization. Medical emergencies and illnesses are never anticipated and a single hospital visit can cost tens of thousands of dollars. Students without health insurance are more likely to withdraw from school for health or financial related reasons.

I already have health insurance. How can I tell if it is good enough?

Even if you have health insurance coverage as a dependent on a parent’s employer plan, it is important to review the policy to ensure that you have adequate coverage in the Madison area. Many plans, especially those from another state, only cover emergency care in Madison. If your plan does not offer local access to primary care and out-patient services, you may have to take time off school to receive appropriate medical attention away from campus.

Individual insurance plans (plans not offered through an employer), should be reviewed carefully. Plans with low premiums and a high maximum benefit may seem attractive, but they often impose unrealistically low caps on specific benefits such as inpatient hospital services. Once the cap is reached the member is responsible for all remaining costs, which can total tens of thousands of dollars. SHIP on the other hand, has a maximum lifetime benefit of $1,000,000 and very few benefit caps.

If you have a high deductible insurance plan, you should be aware that these plans offer lower premiums by shifting much of the medical costs onto their members. Unfortunately, this can make members reluctant or financially unable to receive necessary medical treatment because of the initial cost to them. These plans do not offer comprehensive protection.

Some health insurance plans offer limited or no mental health benefits. Students experiencing a mental health illness may find they have no coverage and are unable to get the care they need to stay in school and complete their academic programs.

Please note that International Students and Scholars are required to enroll in SHIP unless the qualifying criteria on the Waiver Application [pdf] are satisfied. Individual plans do not qualify for a waiver.

How is SHIP different from other health insurance plans?

SHIP caters exclusively to UW-Madison students and scholars. The plan is locally administered through UHS and not by an insurance company. SHIP is motivated by the need to serve the student population effectively, not by profit. Student premiums are designated to cover the cost of claims and improve benefits. As a result, SHIP is able to offer students a comprehensive and accessible health insurance plan at a competitive price.

Can SHIP premiums be included in the UW-Madison Financial Aid package?

Undergraduate students can request that the cost of SHIP insurance be included in their financial aid package calculations. If the student qualifies, the financial aid package may be adjusted to accommodate the expense paid for SHIP coverage. If the student has already received an aid package and then purchases SHIP, the student will have to submit a receipt or other proof of payment of SHIP premiums. Graduate student financial aid packages already include an allowance for health care costs, so in general, no adjustments can be made for these students.

For more information, please contact UW-Madison Student Financial Services by calling 608-262-3060 or by emailing finaid@finaid.wisc.edu.

What is a Deductible?

A Deductible is the amount you must pay annually towards certain categories of medical expenses before insurance benefits begin. This is usually a relatively low amount compared to your overall coverage benefit.

What is a Copayment?

A Copayment is a payment which you make upfront each time you receive certain medical services. When you visit your health care provider, you pay the copayment to the provider, and the plan covers the remaining expenses, subject to any deductible or coinsurance.

What is Coinsurance?

Coinsurance is the percentage of your medical expenses for which you are responsible after any applicable Copayments or Deductible has been satisfied. For example, if a SHIP Domestic student receives outpatient professional services at an “In-Network” provider for the first time, the student would be responsible for meeting the annual Deductible and 20% of the remaining charges. SHIP would cover the remaining 80% up to the plan maximum benefit.

What are Out-of-Pocket expenses?

Out-of-pocket expenses are the portion of medical expenses that you are responsible for. Typically this refers to the combined total of any Deductible and Coinsurance costs for which you are responsible. The Out-of-Pocket maximum is the maximum amount you are responsible for annually. In the case of SHIP, Copayments and non-covered services do not apply towards the Out-of-Pocket expenses.

I am a SHIP member; where do I go if I need medical treatment?

Unless you have a medical emergency, both you (and any covered spouse or partner) must use UHS for all available primary, urgent and preventative care*. This includes UHS Medical Services and Counseling and Consultation Services at 333 East Campus Mall. Call 608-265-5600 to make an appointment. If you have dependent children, please click Find “In-Network” Providers.

*See Waiver of the Primary Care Provider Requirement in the on-line Plan Document for exceptions.

What if I have an emergency?

If you have a medical emergency, dial 911 or go to the nearest emergency room facility. Please remember to always carry your SHIP membership card with you.

If I get sick at night or on weekends what should I do?

If you have a medical emergency, dial 911 or go to the nearest emergency room facility. If you require medical attention, but are unable to use UHS, click Find “In-Network” Providers. Please remember that covered services at “In-Network” providers are subject to any deductible, coinsurance, or copayment responsibilities on your plan.

What is an “In-Network” provider?

SHIP contracts with HealthEOS by MultiPlan so that members have access to a nationwide network of providers at a discounted rate. This means that treatment costs are lower for you when you utilize one of these “In-Network” providers. Please note that a referral is not necessary for services not offered at UHS.

What is an “Out-of-Network” provider?

"Out of Network" refers to a provider which has no special agreement with SHIP. Because there is no agreement, treatment costs and your deductible and co-insurance responsibilities are higher. However, it is unlikely that you will need to use an "Out-of-Network" provider unless you are overseas.

How do I find out if a specific treatment is covered by SHIP?

Specific plan benefits can be verified by contacting the SHIP claims administrator, Maksin Management Corporation, at 1-866-796-7899. Please remember that covered services may still be subject to a deductible, coinsurance and/or copayment. All benefits are payable in accordance with the Plan Documents which can be viewed online. Plan exclusions are also detailed in the Plan Documents.

I have a question regarding a SHIP claim. What should I do?

Claims typically take up to 6 weeks to process. Case specific claims questions should be directed to the SHIP claims administrator, Maksin Management Corporation, at 1-866-796-7899. You can also call the SHIP office at 608-265-5232 if you have any issues or concerns and we can contact Maksin Management on your behalf.

What do I do if I receive a bill for a medical visit?

When you present your SHIP membership card to a provider, they should submit itemized medical bills to the address on the back of the card. Every bill includes universal coding to designate the procedure, diagnosis, and provider. When receiving services at a hospital, two bills are often generated. One is for the hospital charges, use of the facility, equipment and supplies, and a second is for the physician’s charges. Since it typically takes up to 6 weeks to process a claim, you may receive a bill or bills from the provider first. Do not pay any provider bill (except for any copayment) unless you have already received an Explanation of Benefits from the SHIP claims administrator, Maksin Management Corporation. If you do receive any bills for any medical services, you can bring the documentation to the SHIP office. We will then fax the bills to Maksin Management Corporation for determination of patient responsibility and benefits coverage.

What is an Explanation of Benefits?

Once a claim has been reviewed and processed, the SHIP claims administrator, Maksin Management Corporation, will send you an Explanation of Benefits showing what the plan has covered, what discounts have been applied, and what your remaining financial responsibility (if any) is. This is not a bill, so do not send any balance due to Maksin Management Corporation. The provider will receive a separate notification from Maksin Management Corporation and should send you a revised bill for any remaining amount due. Please click Guide to Understanding the Explanation of Benefits [pdf] for additional information.

Who do I contact if I have additional SHIP questions?

SHIP Office (9 am to 5 pm, Mon – Fri) | University Health Services
333 East Campus Mall | 7th floor | Madison
Phone: 608-265-5232 | Fax: 608-265-5668
shipmail@uhs.wisc.edu