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.