This guide will help you plan for the office visit copays you may have to pay when you visit your in-network health care provider.

Copay Tips

  • You are typically required to pay your copay to your provider’s office at the time of your visit
  • Copays are a set dollar amount (e.g., $15 per visit)
  • If you are enrolled in the HDHP or Access HDHP plan designs, you must meet the plan’s annual deductible before office visit copays are applied. Once the deductible is met, then you will pay the office visit copays as described below.

You will not have to pay copays for preventive care office visits (see note above for HDHP and Access HDHP plan designs). Copays are for the non-preventive office visit only, and do not cover any additional services you might receive during your visit (e.g., lab work or x-rays). Additional services are subject to your deductible and coinsurance, until you reach your annual out-of-pocket limit. Here are examples of office visit types and the applicable copays.

 

Office Visit Type

$15 Primary Care Visit

$25 Specialty Visit

Family Practice

 

General Practice

 

Internal Medicine

 

Gynecology/OB

 

Midwives
(if your plan provides in-network midwives)

 

Nurse Practitioners

 

Physician Assistant

 

Pediatrics

 

Urgent Care

 

Chiropractic

 

Home Health Visit

Subject to deductible and coinsurance

Subject to deductible and coinsurance

Palliative Care Visit


For PCP Only


For Specialist Only

Vision Exam

 

Pre/Postnatal Visits

*
For family practice with obstetrics or OB/GYN

*
For maternal/fetal specialist 

Mental Health Visits/Therapy

 

Physical Therapy

Occupational Therapy

Speech Therapy

Other Practitioner

 

*If all prenatal visits are billed as a package at the end of pregnancy, then deductible and 10% coinsurance apply. Check with your doctor’s office for more information.

last updated: 12/1/2017

Every effort has been made to ensure this information is current and correct. This page does not guarantee enrollment or the ability to make changes to your benefits.