Medical - Outpatient

Patient Responsibility for Outpatient Medical Services 

Medical office, phone, & video visits1

UHS Network Provider (outside UHS) Non-Network Provider (outside UHS)2
Primary Care $15 $15 50%3 
Gynecology  $15 $25 50%3
Specialists  $25 $25 50%3

Note: If the visit is at a hospital setting, a facility (hospital) fee may apply. After the deductible, plan pays 90% for network rates or 50% non-network rates.

Adult preventative services & immunizations

UHS Network Provider (outside UHS) Non-Network Provider (outside UHS)
Adult Preventive* Services $0 $0 50%3
Preventive Immunizations** $0 $0 50%3
Other Immunizations 10% 10%3 50%3

*Services include but not limited to, physical exams, preventive screenings, (including screenings for cancer, HPV, diabetes, cholesterol, blood pressure, hearing and vision), and immunizations.

**Preventive Immunization includes Diphtheria/Tetanus/ Pertussis, Measles, Mumps and Rubella; Meningococcal; Varicella; Influenza; Hepatitis A and Hepatitis B; Pneumococcal; Polio; Human Papillomavirus; Cholera; Typhoid; Yellow Fever; Japanese B. Encephalitis; and Lyme Vaccine.

NOTE: Routine immunizations are recommended to be administered at UHS. All immunizations must meet all FDA regulations prior to approval.

Labs, tests, x-rays, & imaging

UHS  Network Provider (outside UHS) Non-Network Provider (outside UHS)2
10% 10%3
 50%3

Prenatal care, maternity, newborn, breast pump, & abortion


UHS Network Provider (outside UHS) Non-Network Provider (outside UHS)2
Prenatal care Not available $0 50%3
Breast Feeding Durable Medical Equipment Not available $0 50%3
Abortion  $0 $0 50%3

Maternity Benefits: See our maternity flier.

Midwives: If you wish to see a midwife, see our list of in-network midwives. (Note: This list is only updated periodically. Please confirm your midwife is still in-network prior to receiving services.)

Newborns4 are covered for the first 31 days from date of birth unless the student’s coverage ends before then. Coverage after the first 31 days of life is offered through the dependent plan. To enroll a newborn, call the SHIP office within 31 days of the baby’s birth.

Acupuncture & Chiropractic Care5


Network Provider (outside UHS) Non-Network Provider (outside UHS)2
$25 50%

Physical Therapy, Occupational Therapy, & Speech Therapy5

UHS Network Provider (outside UHS) Non-network Provider (UHS)2
Physical Therapy $15 $15 50%3
Occupational Therapy & Speech Therapy Not available $15 50%3

Allergy Testing & Injections

Network Provider (outside UHS) Non-Network Provider (outside UHS)2
10%3 50%3

Home Health Visits & Skilled Nursing Facility 

Network Provider (outside UHS) Non-Network Provider (outside UHS)2
10%3 50%3

Note: Home Health Care and Skilled Nursing Facility benefits are limited to 100 visits per policy year.

Durable Medical Equipment1

UHS Network Provider (outside UHS) Non-Network Provider (outside UHS)2
10% 10%3 50%3

For rental or purchase of medical equipment and supplies ordered by a physician and are of no further use when medical need ends. For breast pump coverage, please see maternity benefits. 

Equipment must be obtained from a durable medical equipment supplier, including rental or purchase of diabetic equipment and supplies (excluding insulin). 

Fertility Preservation 

See fertility preservation flyer for benefit details.

1Covered medical expenses incurred for the treatment of hypertension, diabetes, and pre/cervical cancer with network providers are not subject to the deductible, co-pay, or co-insurance. Note: prescription drugs are not included in this new benefit. See the prescription page for prescription co-pays. 

2If services are rendered with a non-network provider, SHIP covers 50% of the usual and customary charge after the deductible is met. Members are responsible for all costs over the usual and customary charge.

3Subject to the $450 deductible. 

4If the student's plan terminates before the 31 days from date of birth, the newborn's coverage ends on the same termination date as that of the student.

5Please note after the 12th visit per plan year, these services are subject to pre-certification and medical necessity review.

This page provides a summary of some benefits. Please see the SHIP Benefits Brochure for plan details.

Topics

Insurance topic page

 Scheduling appointments at Tang