Copayment Amounts Clause Samples

Copayment Amounts. The Copayment Amounts for Generic Drugs filled by a Participating Pharmacy or a mail -order Pharmacy are shown on your Schedule Page. If the Eligible Charge of the Covered Drug is less than the Copayment Amount, you will pay the lower cost. Coinsurance Amounts for a Participating Pharmacy or non -Participating Pharmacy are shown on your Schedule Page. The amount you pay depends on the Covered Drug dispensed. If the Covered Drug dis- pensed is a:

Copayment Amounts. (a) A $25 Copayment Amount will be required for most Physician office visits and/or consultations only when services are provided by a Network Physician or Professional Other Provider at the time You receive the services. If the services provided require You to return on a different day, a new Copayment will be required for any office visits and/or consultation charges. The Copayment Amount is required even if the Coinsurance Amount has been met. The following services are not payable under this Copayment Amount provision, but instead are considered Medical-Surgical Expense, subject to the Deductible and Coinsurance: ▪ Eligible Expenses for other covered charges provided at the time of the office visit or consultation (e.g. lab or X-ray). ▪ Surgery performed in the Physician’s office; ▪ Physical therapy billed separately from an office visit; ▪ Occupational modalities in conjunction with physical therapy; ▪ Allergy injections billed separately from an office visit; ▪ Therapeutic injections; or ▪ Any services requiring preauthorization. (b) The Copayment Amount does not apply when an Out-of-Network Physician or Professional Other Provider renders the services.

Copayment Amounts. In accordance with Exhibit A attached hereto, Jazz Pharmaceuticals shall be responsible for portions of the copayment or coinsurance obligations of patients properly enrolled in the Copayment Program (the “Jazz Copayment Amounts”). Jazz Pharmaceuticals shall pay ESSDS the Jazz Copayment Amounts due within thirty (30) days of Jazz Pharmaceuticals’ receipt of ESSDS’s invoice pertaining thereto. Delinquent payments shall be subject to interest at the rate specified in the Agreement.

Copayment Amounts. There are three Copayment Amounts shown on Your Schedule of Coverage. After the Calendar Year Deductible has been satisfied, the Copayment Amount You pay depends on the type of drug dispensed. If the drug dispensed is a: a. Generic Drug - You pay the Generic Drug Copayment Amount, b. Preferred Brand Name Drug - You pay the Preferred Brand Name Drug Copayment Amount and any pricing difference described below, if applicable, c. Non-Preferred Brand Name Drug - You pay the Non-Preferred Brand Name Drug Copayment Amount. When the Out-of-Pocket Maximum shown in Your Schedule of Coverage has been reached, benefits for Covered Drugs will be provided on the same basis as for other sickness up to the Calendar Year benefit maximum shown on Your Schedule of Coverage for Outpatient Prescription Drugs.