What is a copay? A copay (or copayment) is a flat fee that you pay on the spot each time you go to your doctor or fill a prescription. For example, if you hurt your back and go see your doctor, or you need a refill of your child's asthma medicine, the amount you pay for that visit or medicine is your copay. Your employees will find this plan easy to use thanks to its copay only structure. Blue Elect Plus℠ POS Our point of service plan offers affordability and the freedom to choose a doctor or specialist without a. Acute inpatient hospital care $300 copay per day for days 1-5 $0 copay per day for days 6-90 40% of the cost $0 deductible $0 copay per day for days 1-60 $0 copay per day for days 61-90 $0 copay per day for days 91-150 Lab Services With Medicare only In - Networkre only In - Network With Medicare only Out-of-Network.

These examples show how HMSA calculates your copayment for covered services if your HMSA plan pays 90% of the eligible charge when you see a participating provider and 70% when you see a nonparticipating provider. Copayment%ages may differ. Refer to your Guide to Benefits for your specific copayment%ages.

Physician visit

When your copayment is 10% of the eligible charge for services from a participating physician and 30% for services from a nonparticipating physician:

You have a cold and go to a participating physician to have it checked out.

• The physician’s bill or actual charge is $100.
• HMSA’s eligible charge is $80.
• Your copayment is $8 (10% of $80).

If you went to a nonparticipating physician, you’d owe a copayment of 30% of the eligible charge plus the difference between the eligible charge and the physician’s actual charge. The nonparticipating physician may require payment of the actual charge at the time of service.

• The physician’s bill or actual charge is $100.
• HMSA’s eligible charge is $80.
• HMSA will reimburse you $56 (70% of $80).
• Your total out-of-pocket cost is $44.

*Note: Because services were provided by a nonparticipating physician, your physician may require payment of the actual charge of $100 and you may need to file your own claim.

Excellus Medicare Blue Ppo Copay Plan

Surgical procedure — physician charge

When your copayment is 10% of the eligible charge for services from a participating physician and 30% for services from a nonparticipating physician:

You have a major surgical procedure done by a participating physician.

• The physician’s bill or actual charge is $100,000.
• HMSA’s eligible charge is $40,000.
• Your copayment is $4,000 (10% of $40,000).

If you went to a nonparticipating provider, you’d owe a copayment of 30% of the eligible charge plus the difference between the eligible charge and the physician’s actual charge. The nonparticipating physician may require payment of the actual charge at the time of service.

• The physician’s bill or actual charge is $100,000.
• HMSA’s eligible charge is $40,000.
• HMSA will reimburse you $28,000 (70% of $40,000).
• Your total out-of-pocket cost is $72,000.

Ppo Copay Vs Hdhp

Hmo Vs Ppo Copay

*Note: Because services were provided by a nonparticipating physician, your physician may require payment of the actual charge of $100,000 and you may need to file your own claim.