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Benefit Comparison

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Comparison Points Benefit with T-SHIP at The Health Center on Campus T-SHIP In-Network T-SHIP Out of Network Your Plan
Annual Deductible No Deductible $250 $500 ?

Family Deductible 

 N/A  $750 $1,500 ?
Maximum Out of Pocket Limit No Limit $5,000 Per Insured Person,
Per policy year  $10,000.00 for all Insureds in a family Per Policy year
$5,000 Per Insured Person, Per policy year 
$10,000 for all Insureds in a family Per Policy year
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Office Visit  No Co-pay Community Referral: $25 Co-Pay Community Referral: $25 Co-Pay ?
Emergency Room N/A $100 Co-pay Co-pay + 60% of Usual and Customary Charges for Medical Expense  ?
Urgent Care N/A $25 Co-Pay in addition to Policy Deductible $25 Co-Pay in addition to Policy Deductible ?
Laboratory Services No Co-pay 90% of Preferred Allowance for Covered Medical Expense after deductible is met 60% of Usual and Customary charges for covered expense after deductible is met ?
Inpatient Medical Visit  N/A 90% of Preferred Allowance for Covered Medical Expense after deductible is met 60% of Usual and Customary charges for covered expense after deductible is met ?
Prescription Drugs $15.00 Co-pay Tier 1 $20 Co-pay
Tier 2 $40 Co-pay
Tier 3 $60 Co-pay
$20 Deductible per generic drug  
$60 Deductible per brand name drug
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Physical Therapy  Visit N/A Community Referral: $25 Co-Pay in addition to Policy Deductible Community Referral: $25 Co-Pay in addition to Policy Deductible ?

Medical Coverage while Studying Abroad

N/A

90% of Preferred Allowance for Covered Medical Expense after deductible is met

60% of Usual and Customary charges for covered expense after deductible is met

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