SHIP (Mega)  $898.00

Well Visits

Not Covered *

Specialist Visits

80 or 100% coverage with $100. deductible*  
$2000. max per illness

Consultant 
(2^nd Opinions)

80 or 100% coverage
$100. max

Emergency Room

80 or 100% coverage with $100 deductible*

Prescriptions

$5. for Generic, $15 for Brand Names
$1000. max

Laboratory Testing

80 or100% coverage with $100. deductible*
$2000. max per illness

Out Patient Surgery

80 or 100% coverage with $100. deductible*

Hospitalization

80 or 100% coverage with $100. deductible*   
$100,000.00 max

Mental Health
                      Biological
                      Inpatient

80 or 100% coverage
$100,000.00 max

Biological
Outpatient

80 or 100% coverage with $100. deductible*   
$2000 max per illness

                      Non Biological
                      Inpatient

60 days per year

Non Biological Outpatient

24 visits

Vision Care

Discount at participating EyeMed offices

Dental Care

Not a covered service for routine care.
$500. for injured teeth

High Cost Procedures

80 or 100% coverage  $2000. max per illness

Prosthetic appliance and Orthotic devise

80 or 100% coverage with $100. deductible*   $2000. max per illness