Please review the 23-24 Summary of Benefits and Coverage and note the out-of-pocket maximum and coinsurance required for specialty drugs.

• Out-of-pocket maximum is $8,700 for medical and prescription drug expenses.
• The 5-Tier Plan prescription drug copays:
  • Tier 1: $10 copay (generic)
  • Tier 2: $20 copay (preferred brand)
  • Tier 3: $30 copay (non-preferred brand)
  • Tier 4: 30% coinsurance (preferred specialty)
  • Tier 5: 30% 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:

• Out of Pocket Maximum will increase to $8,700 for combined medical and prescription expenses.
• The prescription drug copayments will change to a 5-Tier Plan:
  • Tier 1: $10 copay (generic)
  • Tier 2: $20 copay (preferred brand)
  • Tier 3: $30 copay (non-preferred brand)
  • Tier 4: 30% coinsurance (preferred specialty)
  • Tier 5: 30% 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.

Continue to the Summary of Benefits and Coverage

The following changes have been made to the 2022-2023 policy:

• Out of Pocket Maximum will increase to $8,700 for combined medical and prescription expenses.
• The prescription drug copayments will change to a 5-Tier Plan:
  • Tier 1: $10 copay (generic)
  • Tier 2: $20 copay (preferred brand)
  • Tier 3: $30 copay (non-preferred brand)
  • Tier 4: 30% coinsurance (preferred specialty)
  • Tier 5: 30% 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.

Continue to the Plan Highlights