Benefit Comparison Chart for 2024-2025 Academic Year
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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, |
$5,000 Per Insured Person, Per policy year |
? |
|
Office Visit |
No Co-pay |
Community Referral: $30 Co-Pay |
Community Referral: $30 Co-Pay |
? |
|
Emergency Room |
N/A |
$100 Co-pay |
Co-pay + 60% of Usual and Customary Charges for Medical Expense |
? |
|
Urgent Care |
N/A |
$30 Co-Pay in addition to Policy Deductible |
$30 Co-Pay in addition to Policy Deductible |
? |
|
In-House 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 |
$20 Deductible per generic drug When Specialty Prescription Drugs are dispensed at a Non-Preferred Specialty Network Pharmacy, the Insured is required to pay 2 times the retail co-pay (up to 50% of the Prescription Drug Charge). |
? |
|
Physical Therapy Visit |
N/A |
Community Referral: $30 Co-Pay in addition to Policy Deductible |
Community Referral: $30 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 |
? |
