This page is best viewed on a full-size monitor. If you're having trouble viewing, please use this printer-friendly version (PDF).
| 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 |
? |
| 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 Tier 2 $50 Co-pay Tier 3 $80 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 |
? |
