Copayments
Each individual is
responsible for certain copayment expenses each time certain covered medical
expenses are incurred. Copayments do not apply toward the $200 annual deductible
or $2,300 annual coinsurance maximum.
$50
Emergency Room Copayment
Each individual is
responsible for the first $50 of covered expenses for each emergency room visit.
If the individual is admitted as an inpatient directly following treatment in
the emergency room, the $50 copayment is waived.
$10
or $20 Office Visit Copayment
Each individual is
responsible for the first $10 of covered expenses when a physician or mental
health care provider bills an office visit. Each individual is also responsible
for an additional $10 of covered expenses when a nonpreferred provider bills an
office visit (for care received in Washington State only). This $10 or $20
office visit copayment does not apply toward the $200 annual deductible or
$2,300 annual coinsurance maximum. Chiropractors, physical, speech and
occupational therapists, and chemical dependency counselors are not subject to
this office visit copayment.
$200
Nonpreferred Inpatient Hospital Copayment
Each
individual is responsible for the first $200 of covered expenses for every
inpatient hospital admission at a nonpreferred provider facility. This $200
copayment does not apply when care is received outside Washington
State.
Prescription
Copayments
Medco Health Retail
Pharmacy Program
- A
$7 copayment for each generic prescription.
- A
$15 copayment for each brand-name prescription listed on the drug program
formulary.
- A
$30 copayment for each brand-name prescription not listed on the drug program
formulary.
Medco
By Mail
- A
$10 copayment for each generic prescription.
- A
$20 copayment for each brand-name prescription listed on the drug program
formulary.
- A
$35 copayment for each brand-name prescription drug not listed on the drug
program formulary.
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