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Patient responsibility for inpatient hospital room & board expenses (services & supplies) (Medical, Mental Health, & Maternity) |
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Network Provider |
Non-network Provider |
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$250 co-pay; then 10%1, 2 |
$500 co-pay; then 50%1, 3 |
1Inpatient hospital services are subject to the $450 deductible (per plan year).
2No cost-sharing for covered medical expenses, including prescriptions, incurred for the treatment of hypertension, diabetes, pre-cervical cancer, and cervical cancer with in-network providers.
3If services are rendered with a non-network provider, SHIP covers 50% of the usual and customary charge after the deductible is met. All costs over the usual and customary charge is the member's responsibility.
Note: Inpatient hospital care in connection with childbirth will be covered for at least 48 hours following a normal delivery (96 hours following a cesarean section).