Your browser does not support JavaScript!
calculators
Member Education
forms and publications
news
about etf
frequently asked questions
contact etf
site map
related links
home
top of page
Wisconsin Department of Employee Trust Funds header image It's Your Choice 2017 Local Traditional Health Plan Insurance Program
members retirees employers governing boards careers at etf
skip to end of menu
2017 It's Your Choice - Local Traditional Health Plan Insurance for Employees and Retirees
Wisconsin Department Of Employee Trust Funds It's Your Choice 2017


Local Traditional Plan
Insurance for Employees
and Retirees
(PO2, PO12)


Guide to Office Visit Copayments

Here is a guide to help you plan for what office visit copayments you may have to pay when you visit your health care provider.

Copayments Tips

  • 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

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, until you reach your out-of-pocket limit. Here are examples of office visit types and the applicable copayments.

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.

Disclaimer:
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: 8/15/2016 4:33:23 PM