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Wisconsin Department of Employee Trust Funds header image It's Your Choice 2016 State of Wisconsin Group Health Insurance Program
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Wisconsin Department Of Employee Trust Funds

It's Your Choice 2016

State of Wisconsin
Group Health Insurance Program
(State Employees, Retirees, Continuants and Graduate Assistants)

Guide to Office Visit Copayments

Beginning in 2016, you may have to pay copayments when you visit your doctor. Copayments are different from coinsurance in a few ways:


  • You are typically required to pay your copayment to your doctor’s office at the time of your visit
  • Copayments are a set dollar amount (e.g. $15 per visit)
  • Deductible may not apply, depending on your health plan design


  • Doctor’s office/clinic mails you a bill after your visit
  • Coinsurance is a percentage of the amount owed to the doctor/clinic (e.g. 10%)
  • Deductibles must be paid before coinsurance applies

You will not have to pay copayments for preventive care office visits. Copayments are for the office visit only, and do not cover any additional services you might receive during your visit (e.g. lab work or x-rays). Any additional services are subject to your deductible and coinsurance. Examples of services and the applicable copayments are listed in the chart below.

Office Visit Type

$15 Primary Care Visit

$25 Specialty Visit

Family Practice


General Practice


Internal Medicine






Nurse Practitioners


Physician Assistant




Urgent Care




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.

Every effort has been made to ensure that this information is accurate, but may be subject to change. Please note revision dates located at the bottom of each page. In the event of conflicting information, federal law, state statute, state health contracts and/or policies and provisions established by the State of Wisconsin Group Insurance Board shall be followed.

This page was last modified on: 11/16/2015 5:56:27 PM