CORRIDOR
DEDUCTIBLE
EXPLAINED
2015-2016 SHIP
Part 1
Student Health Insurance Plan
DEDUCTIBLES, COINSURANCE, & OOP MAX
Initial Deductible
$500 PPO / $1,000 non-PPO (per Policy Year)
Coinsurance
80% PPO / 0% non-PPO (for most benefits)
Corridor Deductible
$4,500 (per Policy Year)
NOTE:
Preventive care, in
accordance with the
Affordable Care Act, is
always covered at 100%
in network, with no
copays, coinsurance,
or deductible.
The Corridor Deductible will not be applied until SHIP has paid $1,500 in Covered Medical Expenses.
Out-of-Pocket Maximum
$6,350 (per Policy Year)
PPO = Preferred Provider In-Network; non-PPO = Out-of-Network Provider
HOW IT WORKS
1
2
3
4
5
Examples on this sheet are based on PPO providers only.
DEDUCTIBLE
Insured student pays first $500 PPO (initial deductible)
before SHIP pays any charges.
RUNNING TALLY
SHIP’s Total
Student’s Total
$0
$500
FIRST BENEFIT LEVEL
RUNNING TALLY
CORRIDOR DEDUCTIBLE
RUNNING TALLY
SECOND BENEFIT LEVEL
RUNNING TALLY
THIRD BENEFIT LEVEL
GRAND TOTAL
After $500 PPO deductible is paid, student and SHIP share
expenses– SHIP pays 80%, up to $1,500, and the student
pays 20% coinsurance, up to $375.
After SHIP has paid out $1,500 in covered charges as outlined above, student must meet the corridor deductible of
$4,500 before SHIP will pay further covered charges.
After student meets corridor deductible of $4,500, student
and SHIP share expenses – SHIP pays 80%, student pays
20% – up to $6,350 total maximum out of pocket.
After student meets the out-of-pocket maximum of $6,350,
SHIP pays 100% of covered charges, up to the policy
maximum benefit (unlimited).
See some “real-life” examples on page 2.
SHIP’s Total
$1,500
SHIP’s Total
$1,500 SHIP’s Total
$1,500 + $4,875 = $6,375
SHIP’s Total
$6,375 + 100% of remaining charges
Student’s Total
$500 + $375 =
$875
Student’s Total
$875 + $4,500 =
$5,375
Student’s Total
$5,375 + $975 =
$6,350
Student’s Total
$6,350
a
Note: This document, including the examples listed, is for explanation only, and not a guarantee of benefit payments. All claims are subject
to adjudication as well as plan exclusions and limitations.
CORRIDOR
DEDUCTIBLE
EXPLAINED
2015-2016 SHIP
HOW IT WORKS IN BRIEF:
1 Initial Deductible
Student pays $500 for PPO expenses
2 First Benefit Level
SHIP pays 80% PPO, up to $1,500, student pays 20%, up to $375
3 Corridor Deductible
Student pays $4,500
Part 2
Student Health Insurance Plan
The Corridor Deductible will not be applied until SHIP has paid $1,500 in Covered Medical Expenses.
4 Second Benefit Level
SHIP pays 80% PPO; student pays 20%, up to $6,350 total
out-of-pocket (per Policy Year)
5 Third Benefit Level
SHIP pays 100% PPO for remaining covered charges
NOTE:
Preventive care, in
accordance with the
Affordable Care Act, is
always covered at 100%
in network, with no
copays, coinsurance,
or deductible.
PPO = Preferred Provider or In-Network
EXAMPLES:
Below are some examples of how the corridor deductible might be played out in a
real-life situation. These examples are for illustration only.
Examples on this sheet are based on PPO providers only.
Joe has a $1,000 medical bill after PPO discounts are applied. He pays the $500
deductible, then SHIP pays $400, or 80% of the balance. Joe would then owe
the doctor the remaining 20%, or $100. Joe’s total out-of-pocket is $600.
Gwen has $20,000 in covered medical expenses after PPO discounts are applied. She pays
the $500 deductible. Then SHIP pays 80% ($1,500), and Gwen pays 20% ($375) of the next
$1,875 in expenses.
She then hits the corridor deductible, and pays $4,500. Gwen has now paid $5,375. After
that, Gwen and SHIP share the cost, up to the out-of-pocket maximum, meaning SHIP will
pay 80% ($4,875) and Gwen will pay 20% ($975). SHIP will then cover the remaining $7,275
of covered charges at 100%. Of the $20,000 in medical expenses, Gwen pays $6,350 total
out-of-pocket and SHIP pays a total of $13,650.
Once you, the student, has paid out a maximum of $6,350 in combined PPO and non-PPO eligible
expenses per Policy Year, you do not have to pay any more deductibles, co-insurance, copays,
whether the expenses are medical or prescription claims. The SHIP plan will pay 100% of all
remaining expenses for the Policy Year and you, the student, will pay 0% of eligible expenses for
the remainder of the Policy Year. This includes prescription copays so you will not pay copays for
covered prescription drugs once you have paid out $6,350 in eligible expenses. If you have any
questions on how the Corridor Deductible works, or you have other claims questions, call the
claims administrator, AmeriBen, at 1-800-953-1801, Group # 0801031.
Note: This document, including the examples listed, is for explanation only, and not a guarantee of benefit payments. All claims are subject
to adjudication as well as plan exclusions and limitations.