1For the 2023-24 plan year, beginning August 1, 2023: No 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.
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 (once per plan year).
4If services are rendered with a non-network provider, SHIP covers 100% of the usual and customary charge. Members are responsible for all costs over the usual and customary charge.
5If 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.
6Please note after the 12th visit per plan year, these services are subject to pre-certification and medical necessity review.
Note: This page provides a summary of some benefits. Please see the SHIP Benefits Brochure for plan details.