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Phone: (805) 756-1211
Fax:     (805) 756-5298
health@calpoly.edu

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Access to Health Services

What about Health Insurance?

Per Executive Order 943, Health Services will provide general medical care to all matriculated students who have paid the appropriate mandatory Health Services Fee. 

Campus Health & Wellbeing strongly recommends carrying private health insurance for medical and surgical problems beyond the scope of Cal Poly's Health Services. Each student is encouraged to have their own coverage for major medical, surgical and emergency expenses. Cal Poly cannot pay for off-campus care; therefore, an individual is responsible for those charges. We recommend consulting with an insurance broker to find the best available insurance coverage for you or Covered CA to choose a plan.

You can also meet with a SLO County Public Health Department's Healthcare Access Navigator. To learn more or get help with a health care question: call 805-781-4838 or visit SLO County Health Care Navigation.

What kind of insurance do I have? How does it work?

It is very important that you know what kind of insurance you have: HMO, PPO, or indemnity insurance. The most critical information is to know whether you need pre-approval for a medical service in order to be reimbursed for your expenses by your insurance company. Call the customer service number on your insurance card to find out.

Health Maintenance Organizations (HMOs)

  • Most medical services (other than care from your primary care provider or emergency services) will require pre-approval from your HMO.
  • Without pre-approval, your insurance company will refuse to pay your claim, and you will be responsible for the entire bill.
  • Please call the phone number listed on your insurance card for pre-approval.
  • If you plan on living in San Luis Obispo County for the school year or longer, you may want to consider changing your primary care provider in this county, since their approval will be needed for a referral to a specialist. This will save you a visit to your primary care provider (out of SLO) for that approval.

Indemnity Insurance Plans (Fee for Service)

Indemnity insurance plans simply pay a percentage of your medical expenses after your deductible has been met (i.e. you have a $500 deductible plan and the insurance will not pay for the first $500 of the expenses you incur) . In most instances you will not have to submit bills for medical care, but you will probably have to submit bills for pharmacy items and medical supplies in order to be reimbursed.

Preferred Provider Organizations (PPOs)

Preferred provider organizations insurance is similar to indemnity insurance plans. PPOs create groups of providers that you can see at a discount. For example, they may pay 80% of your bill if you see someone from their preferred provider list, but may only pay 60% if you see someone who is not on their list. Frequently, there is a deductible. If you have a $500 deductible plan, the insurance will not pay for the first $500 of your expenses.

Information to Know

Inpatient Hospital Care

Hospital care is extremely expensive. If you are going into the hospital, it is critical that you follow the correct procedures set by your insurance company. If you are covered by an HMO, your hospital stay must be pre-approved by the HMO or you stand a high probability that they will not pay for your care. The hospital admitting office should help with pre-authorization, but in order for them to do that effectively they need your insurance card. Be sure to carry it with you at all times.

When You Need to Use Private Insurance

  • Emergency services
  • Hospitalization
  • Urgent services that occur after Health Center hours requiring a visit to an urgent care facility outside of CH&W
  • Services of medical specialists not seen at the Health Center
  • Basic medical services away from campus (you can receive basic health services at any Cal State University campus if you are a currently enrolled Cal Poly student)

What are my insurance options after graduation?

As graduating seniors begin departing for the next chapter of their lives, insurance options may be confusing.  Obtaining health insurance through employer-based coverage or staying on a parent's plan until the age of 26 are two options.  In addition, this health coverage website provides the ability to choose a plan in the Health Insurance Marketplace. As you may know, graduation is a general milestone for many significant life changes, such as expired student health insurance or moving from home, that trigger a "Special Enrollment Period" that allows a 60 day window for students to sign up for coverage in the marketplace even though the open enrollment period has ended.  

Insurance Checklist 

  • IF YOU HAVE A MEDICAL EMERGENCY, CALL 911 OR GO TO THE NEAREST EMERGENCY ROOM!
  • Carry your health insurance card at all times.
  • If you have HMO coverage, call for pre-approval of all non-emergency services.
  • If you have PPO coverage, find the appropriate provider from your provider list for this area.
  • If you have indemnity insurance, contact the provider of your choice.
  • Keep all receipts for services, doctors' costs, pharmacy items, and medical equipment. It may be necessary to submit these to your insurance company at a later date.
  • Know which pharmacies accept your health plan. If there is no pharmacy in this area, check to see if the Health Center Pharmacy has the medication. Our prescription prices are generally the best in town.

 

Access to Health Services

Currently Enrolled Students

One who is enrolled in the current quarter. No additional visit fee or in-house lab charges apply. Students will be responsible for outside lab fee(s), prescriptions, and specialty clinic fees.

Continuing Student

Continuing students (enrolled the previous quarter, not enrolled for the current quarter but plan to be enrolled for the next quarter) may be seen, subject to fee-for-service charges.

Graduated/Non-Returning Student

Graduated/non-returning students may be seen for one courtesy visit after graduation, including lab testing, X-rays and pharmacy services. The purpose of this visit is to resolve a concern discussed in a previous visit and to issue an appropriate referral. The visit and additional services are subject to fee-for-service charges.

Participants of campus-sponsored programs

Participants of campus-sponsored programs (i.e. Extended Education, Quarter Plus) are eligible for health services, if the Health Services Fee was charged that quarter. Students cannot choose to pay this fee if the fee is not automatically applied to their student account.

Students from other CSU campuses

Students eligible for basic services at one CSU campus shall be eligible for basic services provided by other CSU campuses. Basic services are office visits, immunizations, lab tests, X-rays, pharmacy services, and others as stipulated in Executive Order 943. Some fees for service may apply.

Visitors

Visitors will be seen for emergency first aid only (one-time treatment that does not require a physician or laboratory, X-ray, or pharmacy services).

Staff/Faculty

Staff and faculty can be treated for emergency first aid for work-related injuries only. Emergency first aid is defined as one-time treatment that typically does not require a physician or laboratory, X-ray, or pharmacy services. For more information, please refer to the Workman’s Compensation website.

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