An office visit copay is the flat dollar amount that you would pay for a routine visit to either a primary care physician or a specialist, with coverage kicking in at 100% after the copay. Most traditional, employer sponsored plans offer an office visit copay. However, individual and family plans may or may not include office visits copays as part of the coverage.
SOME of the plans listed in your instant quote will not offer copays for routine office visits. If you see “$0″ or “N/A” in the Copay column on your instant quote, then those plans will not have an office visit copay. On plans with no office visit copay, routine office visits will typically apply to your deductible, and you will be responsible to pay the network-discounted rate for office visits until your deductible is met. On some of the catastophic plan designs with no copays, routine office visits may not even be covered at all!
Carriers that do not offer office visit copays on their basic plan design will usually give you the option to add office visit copays for an additional premium. Please remember that when you pay a copay on a PPO plan, your deductible IS NOT reduced by the amount of that copay. Copay expenses, whether for office visits or prescriptions, are unlimited and never included in your PPO plan’s maximum out-of-pocket limit.
Originally posted 2009-10-09 04:54:29. Republished by Blog Post Promoter