- Coverage periods:
- Fall 2022: August 1, 2022 - December 31, 2022
- Spring 2023: January 1, 2023 - July 31, 2023
- SHIP's medical insurance carrier is Wellfleet. Wellfleet utilizes Blue Shield of CA PPO provider network for services in California and Cigna PPO for services outside of California.
- There is a $450 per plan year deductible for some medical services provided outside of UHS. The plan year is from August 1 to July 31.
- If services are obtained from non-network providers or facilities, claims are paid at 50% of the non-network rate (customary and reasonable), which is significantly lower than the network coverage.
- Medical and behavorial health providers may contact Wellfleet Member Services at (833) 302-9785 to verify benefits and eligibility.
In-Network Benefit Summary
|Preventative||100% covered ($0 co-pay)|
|Primary Care||$15 co-pay for office visits|
|Physical Therapy||$15 co-pay for office visits|
|Specialists||$25 co-pay for office visits|
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
|Emergency Room||$250 co-pay (waived if admitted; deductible waived)|
|Hospitalization||$250 co-pay per admission; then 10% co-insurance after the deductible|
|Labs/Tests/X-rays||10% co-insurance (subject to deductible outside UHS)|
SHIP members are not required to use the UHS Tang Pharmacy.
Outside Tang at Participating Retail Pharmacies:
|Dental||100% coverage for exams and cleanings twice per year, 80% coverage for basic services, and 70% coverage for major services (up to $2,000 benefit maximum per year). $25 deductible applies to basic and major services.|
|Vision||$10 co-pay for eye exam, $25 co-pay for glasses (up to $150/year) or contact lenses (up to $150/year)|
|Deductible||*$450 for some medical services outside of the Tang Center|