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

Salem State Qualifying Life Event

Students who waived the Student Health Insurance Plan (SHIP) and recently lost their other coverage or moved to the US can contact the Navigation Center at NavCenter@salemstate.edu or 978-542-8000 to request a qualifying event enrollment form. The deadline to complete the enrollment form is 60 days from the qualifying life event.

Students will be asked to provide supporting documentation and the prorated premium will be added to the tuition statement. The first day of coverage in the Salem State SHIP will be the first day without coverage under the prior plan or entry into the US.