| Patient Responsibility | UHS | Network Provider (outside UHS) | Non-Network Provider (outside UHS) |
| Urgent Care | $35 co-pay; then 10% | $50 | $501 |
| Emergency Room | Not available | $250 (co-pay waived, if admitted) | |
| Ambulance (Ground, Air & Water Transportation) | Not available | 20% | |
1If services are rendered with a non-network provider, SHIP covers 100% of the usual and customary charge after a co-pay of $50. All costs over the usual and customary charge is the member’s responsibility.