Some members will make low copays for some care. You will get health care even if you can’t pay the copay when you get the care. But you may have to pay the copay later. It will be up to your doctor or other provider to collect the full copay.
The services below will have these copays:
- Doctor’s office visits (doctor, nurse practitioner) — $3.30 copay for PCP and specialist visits
- Chiropractor — $1.15 copay
- Medical equipment and supplies — $3.40 copay
- Home health visits — $3.30 copay per visit
- Drugs your doctor orders (per drug) — $3.40 copay for generic or brand-name drugs
- Care given during hospital stay (inpatient) — $25 copay
- Care given at a hospital (outpatient) —
other than ER visits — $3.40 copay
- Optometrist (eye doctor) — $3.30 copay
- Podiatrist (foot doctor) — $1.15 copay
- Ambulatory Surgical Center — $3.30 copay
- Federally Qualified Health Center (FQHC) — $3.30 copay
- Rural Health Clinic (RHC) — $3.30 copay
These members are excluded and will have no copays:
- Children under 19 years of age.
- Pregnant women.
- Members receiving family planning services.
- Members in institutions (nursing facilities or intermediate care facilities for the mentally retarded).
- Members getting emergency care in the ER.
- Members getting Medicaid hospice benefits.
- Members of a federally recognized American Indian tribe won’t pay most copays. Tribal members won’t pay for services from the Catawba Service Unit in Rock Hill, South Carolina, or when referred to a specialist or other medical provider by the Catawba Service Unit.
There are no copays for these services:
- Medical equipment and supplies given by the Department of Health and Environmental Control (DHEC)
- Family planning care
- End-stage renal disease care
- Infusion center care
- Preventive care or urgent care visits
Additional Copay Information: