Please review the 24-25 Summary of Benefits and Coverage and note the deductible and coinsurance required for specialty drugs.

• Policy year deductible will increase from $250 to $500
• Emergency Room copay will increase from $100 to $250
• X-ray, High-Cost Imaging and Hospital Stay coinsurance will increase from 10% to 20%
• Outpatient Surgery copay will change from $250 to a 20% coinsurance
• There will be a separate $250 Prescription deductible
• The prescription drug copay and coinsurance for each tier will change to:
  • Tier 1: $20 copay (generic)
  • Tier 2: $40 copay (preferred brand)
  • Tier 3: $60 copay (non-preferred brand)
  • Tier 4: 60% coinsurance (preferred specialty)
  • Tier 5: 60% coinsurance (non-preferred specialty)

To look-up your prescription medication in the 5-Tier Plan, choose Prescription Info → Medication Look Up in the navigation menu on the left.

We encourage students anticipating high out-of-pocket costs to compare other insurance options to the SHIP. The Massachusetts Health Connector offers information about their online insurance marketplace where you can compare and purchase insurance plans. You may be eligible for a Subsidized Health Plan (a low or no cost insurance program for qualifying uninsured adults).

I have read and acknowledge the above statements

The following changes have been made to the 2022-2023 policy effective August 26, 2022:

• Out of Pocket Maximum will increase to $8,700 for combined medical and prescription expenses.
• The Office Visit Copay will change to $25 for in-network Primary Care and $40 for in-network Specialist and Urgent Care
• The prescription drug copayments will change to a 5-Tier Plan:
  • Tier 1: $15 copay
  • Tier 2: $30 copay
  • Tier 3: $50 copay
  • Tier 4: 30% coinsurance
  • Tier 5: 30% coinsurance

Choose Prescription Info → Medication Look Up in the navigation menu on the left to look-up your medication by name in the 5-tier plan.

Continue to the Summary of Benefits and Coverage

The following changes have been made to the 2022-2023 policy effective August 26, 2022:

• Out of Pocket Maximum will increase to $8,700 for combined medical and prescription expenses.
• The Office Visit Copay will change to $25 for in-network Primary Care and $40 for in-network Specialist and Urgent Care
• The prescription drug copayments will change to a 5-Tier Plan:
  • Tier 1: $15 copay
  • Tier 2: $30 copay
  • Tier 3: $50 copay
  • Tier 4: 30% coinsurance
  • Tier 5: 30% coinsurance

Choose Prescription Info → Medication Look Up in the navigation menu on the left to look-up your medication by name in the 5-tier plan.

Continue to the Plan Highlights