SHIP Dental Coverage

The SHIP includes coverage for limited dental services. All students enrolled in the SHIP have access to the benefits provided for eligible dental services. SHIP dental benefits are not available to those students who have waived SHIP.

What services are covered by SHIP?

The SHIP provides coverage for certain Preventive services such as cleanings, exams and x-rays, and Basic services such as fillings and extractions. For eligible dental services, a $50 plan year deductible will apply. The plan provides a benefit from 100-50% depending on the service being provided. The maximum benefit payable for eligible dental charges is $1,500 per plan year. Please refer to the SHIP brochure for a complete schedule of dental benefits. The SHIP brochure includes a list of services that are eligible, as well as those that are not covered. Dental benefits start on page 32.

Is there a waiting period for dental services under SHIP?

There is no waiting period for covered Preventive services however the plan requires that you be continuously insured under the plan for six months before you become eligible for covered Basic services. If there is a break in coverage under the SHIP, you will be required to satisfy another 6-month waiting period upon re-enrollment into the SHIP.

What does "prophy" mean?

Prophy is short for prophylaxis, which means preventive cleaning. The plan provides coverage for one regular preventive cleaning every six months. The plan does not provide coverage for deep cleaning, which is a different level of preventive cleaning that usually includes cleaning the teeth below the gum line.

Does SHIP provide coverage for removing my wisdom teeth?

Extraction of your wisdom teeth would be considered Oral Surgery (Basic Service), which is covered at 50% after the deductible. The 6-month waiting period applies to this type of service. The plan excludes certain types of anesthesia such as intravenous sedation and general anesthesia however local anesthesia (where only an area of your mouth is numbed) is usually included as part of the charge for the extraction.

Is there a referral requirement for dental services?

Unlike the medical benefits under the SHIP, there is no referral requirement to access your dental benefits. You may self-refer to any dentist of your choice.

How do I find a dentist covered by the plan?

You may self-refer to any dentist of your choice however we recommend that you select a PPO dentist from the www.firstdentalhealth.com network to receive discounted rates for services provided. The discounted rates even apply to services that are not eligible under the SHIP. There are no dentists at UCSD SHS.

What do I need to give to my dentist to use SHIP?

The insurance card located on the back of the SHIP brochure is used for accessing medical and dental benefits. The card includes all of the information your dentist will need in order to verify eligibility or benefits, or to file a claim. Once you have selected a dentist, you should check with them regarding their billing and claim process.

Will I have to pay for my dental services up front?

Many dentists will agree to bill your insurance plan on your behalf, and only require pre-payment for what they estimate will not be covered by the plan. If your insurance plan ends up paying less than what they estimated, they will send you a bill for the difference. You should always reconcile your dental bills with the Explanations of Benefits (EOB) from PIA (the claim administrator for the SHIP) to make sure you are paying the correct amount.

See How to File a Claim for more information.