It's Your Choice 2018
Local Health Plan
Insurance for Employees
and Retirees
(PO6, PO16)
Guide to Office Visit Copayments
Copayment 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: 9/18/2017 7:38:22 PM