The 2024-2054 waiver form is closed. If you have an extenuating circumstance, please contact the Student Navigation Center at NavCenter@salemstate.edu.
The waiver form for NEW spring students will be available in November.
Student Health Plan
- Waiver Form
- Enrollment Form
- Qualifying Event Enrollment
- Provider Search
- Worldwide Providers &
Travel Assistance - Insurance ID Card
- Update Mailing Address
Optional Plans
Additional Information
Please note, with the rising costs of healthcare, and increase in utilization of the Plan, the following plan changes have been imposed for the 2024-2025 academic year to help keep the insurance premium and the plan a viable option for all students.
- Deductible will be $500
- Out-of-pocket maximum will be $9,100
- In-network preventive care - deductible will not apply.
- In-network office visit copay will be $30 for primary and mental health visits and $65 for specialist visits (deductible will not apply in-network).
- Emergency room copay will be $200 (deductible will not apply).
- Ambulance services - new deductible will not apply.
- Diagnostic Tests & X-rays - In-network copays will be $50 for lab and $100 for x-ray (deductible does not apply). Out-of-network will be a 20% coinsurance.
- Imaging (CT/PET scans, MRIs will be a 20% coinsurance in-network/40% coinsurance out-of-network
- The 5-Tier Plan prescription drug copays: deductible does not apply
- Tier 1: $20 copay (generic)
- Tier 2: $40 copay (preferred brand)
- Tier 3: $60 copay (non-preferred brand)
- Tier 4: 50% coinsurance (preferred specialty)
- Tier 5: 50% 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).
Please note, with the rising costs of healthcare, and increase in utilization of the Plan, the following plan changes have been imposed for the 2024-2025 academic year to help keep the insurance premium and the plan a viable option for all students.
- Deductible will be $500
- Out-of-pocket maximum will be $9,100
- In-network preventive care - deductible will not apply.
- In-network office visit copay will be $30 for primary and mental health visits and $65 for specialist visits (deductible will not apply in-network).
- Emergency room copay will be $200 (deductible will not apply).
- Ambulance services - new deductible will not apply.
- Diagnostic Tests & X-rays - In-network copays will be $50 for lab and $100 for x-ray (deductible does not apply). Out-of-network will be a 20% coinsurance.
- Imaging (CT/PET scans, MRIs will be a 20% coinsurance in-network/40% coinsurance out-of-network
- The 5-Tier Plan prescription drug copays: deductible does not apply
- Tier 1: $20 copay (generic)
- Tier 2: $40 copay (preferred brand)
- Tier 3: $60 copay (non-preferred brand)
- Tier 4: 50% coinsurance (preferred specialty)
- Tier 5: 50% 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).
Please note, with the rising costs of healthcare, and increase in utilization of the Plan, the following plan changes have been imposed for the 2024-2025 academic year to help keep the insurance premium and the plan a viable option for all students.
- Deductible will be $500
- Out-of-pocket maximum will be $9,100
- In-network preventive care - deductible will not apply.
- In-network office visit copay will be $30 for primary and mental health visits and $65 for specialist visits (deductible will not apply in-network).
- Emergency room copay will be $200 (deductible will not apply).
- Ambulance services - new deductible will not apply.
- Diagnostic Tests & X-rays - In-network copays will be $50 for lab and $100 for x-ray (deductible does not apply). Out-of-network will be a 20% coinsurance.
- Imaging (CT/PET scans, MRIs will be a 20% coinsurance in-network/40% coinsurance out-of-network
- The 5-Tier Plan prescription drug copays: deductible does not apply
- Tier 1: $20 copay (generic)
- Tier 2: $40 copay (preferred brand)
- Tier 3: $60 copay (non-preferred brand)
- Tier 4: 50% coinsurance (preferred specialty)
- Tier 5: 50% 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).
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.