Benefit Comparison

Benefit Comparison Chart for 2023-2024 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,
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  
$50 Deductible per brand name 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

?