SHIP Benefits

Services

In-Network Benefit Summary

UHS: $35 co-pay for visit, then 10% co-insurance for ancillary charges

Outside UHS: $50 co-pay 

UHS: $0 co-pay for short term counseling

Outside UHS: $15 co-pay

Prescription Drugs

SHIP members are not required to use the UHS Tang Pharmacy.

• $0 for preferred generics
• $25 co-pay for preferred brand & high cost generics
• $40 co-pay for non-preferred
• $75 co-pay for specialty medications

Outside Tang at Participating Retail Pharmacies:

• $20 co-pay for preferred generics
• $40 co-pay for preferred brand & high cost generics
• $60 co-pay for non-preferred 
• 20% co-insurance, up to $250 co-pay for specialty medications 

• $2,000 benefit maximum per year
• $25 deductible applies to basic and major services
• $0 for exams and cleanings (twice per plan year)
• 20% co-insurance for basic services (e.g., fillings, deep cleaning)
• 30% co-insurance for major services (e.g., bridges, crowns)

• $10 co-pay for eye exam
• $25 co-pay for glasses (up to $150/year) OR contact lenses (up to $150/year)

Coronavirus Coverage

Please see SHIP updates for benefit changes effective May 12, 2023.

Effective May 12, 2023:

• At-home OTC COVID-19 tests are no longer covered. (Please see the OTC COVID-19 testing page for coverage and reimbursement details on purchases made between January 15, 2022 and May 11, 2023.)
• Coronavirus lab testing due to symptoms or exposure: 
  • In accordance with §1342.2 of the CA Health and Safety Code, Wellfleet will continue to cover non-surveillance COVID-19 testing without member cost sharing until November 11, 2023 for services in California.
  • In all other states, COVID-19 lab tests due to symptoms or exposure are covered under the diagnostic laboratory, testing and imaging services benefit; members will pay their copay, coinsurance or deductible based on the schedule of benefits for in-network or out-of-network benefits of the plan.
• Coronavirus treatment (including evaluation and management visits): Benefits for COVID-19 treatment including associated COVID-19 diagnosis's will be paid according to the schedule of benefits. Members will pay their copay, coinsurance or deductible based on the in-network or out-of-network benefits of the plan.