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 Office
Visit Copayment – For Non-Medicare Individuals Only
Each individual
is responsible for the first $10 of covered expenses when a preferred or
nonpreferred physician or mental health care provider bills an office visit.
This $10 office visit copayment is in addition to the $10 office visit copayment
for an office visit billed by a nonpreferred provider, and these office visit
copayments do not apply toward the $200 annual deductible or $2,300 coinsurance
maximum. Chiropractors, physical, speech and occupational therapist, and
chemical dependency counselors are not subject to this office visit
copayment.
$10
Nonpreferred Provider Office Visit Copayment – For Non-Medicare
Individuals Only
Each individual
is responsible for the first $10 of covered expenses when a nonpreferred
provider bills an office visit. This $10 copayment does not apply to office
visits when care is received outside Washington State.
$200
Nonpreferred Inpatient Hospital Copayment – For Non-Medicare Individuals
Only
Each individual
is responsible for the first $200 of covered expenses for inpatient hospital
admissions at a nonpreferred provider facility. This $200 copayment does not
apply to inpatient hospital admissions 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
Health Home Delivery
Pharmacy
Service
- 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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