Copays Clause Samples
The COPAYS clause defines the portion of healthcare costs that a patient is required to pay out-of-pocket for specific medical services, with the remainder covered by their insurance plan. Typically, this clause outlines fixed amounts or percentages that apply to services such as doctor visits, prescriptions, or emergency care, and may vary depending on the type of service or provider. Its core practical function is to allocate a share of healthcare expenses to the patient, thereby managing insurance costs and encouraging responsible use of medical services.
Copays. The copay for an office visit to a primary care provider (including OB- GYN) will be no greater than $10. The copay for a specialist office visit will be no greater than $15. The copay for each visit to an emergency room will be no greater than $25, however, the applicable emergency room copay will be waived if the associate or eligible dependent is admitted to the hospital.
Copays. Emergency Room: Effective January 1, 2021, the copay for visits to an emergency room will be $140, and effective January 1, 2023, the copay for visits to an emergency room will be $150. (Amend the following sections of the VMEP: Sections 5.1.2 and 5.2.1.)
Copays. Notwithstanding the foregoing, for Covered Retirees and their dependents who are Medicare eligible, the copays for 2016 for the HCN Option set forth in Section VIII.2.C.1.(d) of this 2016 MOU and for the Health Care PPO Option set forth in Section VIII.2.C.2(d) of this 2016 MOU shall not apply. Instead, for 2016 the copays for such Covered Retirees and their eligible dependents will be no greater than $10 for an office visit to a primary care provider (including OB-GYN), no greater than $15 for a specialist office visit and no greater than $25 for an emergency room visit, however, the applicable emergency room copay will be waived if the associate or eligible dependent is admitted to the hospital. For chiropractic services under the Health Care PPO, the copay for such Covered Retirees will be no greater than $20 for services with a licensed chiropractor on an out-of-network basis.
Copays i. Copay for an office visit to a primary care provider (including OB-GYN) will be no greater than $20.
ii. Copay for a specialist office visit will be no greater than $25.
iii. Copay for an emergency room visit will be no greater than $75.
iv. Copay for inpatient hospital admissions will be no greater than the copay on the Effective Date of this 2012 MOU.
Copays. All copays are due at the time of service prior to being seen. Each child has their own copay.
a. There is an additional administrative charge of $10.00 for each copay that must be billed after the date of service.
Copays. All copays are due at the time of service prior to being seen. Each child has their own copay.
Copays. Notwithstanding the foregoing, for Covered Retirees and their dependents who are Medicare eligible, the copays for the MCN Option set forth in Section VI.2.C.1(d) of this 2017 MOU and for the MEP PPO Option set forth in Section VI.2.C.2(d) of this 2017 MOU shall not apply. Instead, the copays for such Covered Retirees and their eligible dependents will be no greater than $10 for an office visit to a primary care provider (including OB-GYN), no greater than $15 for a specialist office visit and no greater than $25 for an emergency room visit, however, the applicable emergency room copay will be waived if the employee or eligible dependent is admitted to the hospital.