...Services $225 copay $225 copay Urgent Care $45 copay $35 copay Emergency Care $90 copay $90 copay Lab Services and Other Tests (In-Network) Laboratory Tests $35 copay $0 Diagnostic Tests...

...of the cost (like the copayments, coinsurance, and deductible) that you would pay if the provider or facility was in-network. Your health plan will pay any additional costs to out-of-network...

...Advantage® Zero Premium (HMO) CareSource Advantage® (HMO)   Covered/ Not Covered Copay/ Coinsurance Covered/ Not Covered Copay / Coinsurance Preventive Dental Covered $0 Copay Covered $0 Copay, $1,000 annual limit...

...covered services, the health care services that are not covered by the plan, and the annual deductible, copayments, and coinsurance you must pay when you receive covered services. Select your...

...share the cost of services. Cost shares are stated as copays, coinsurance, and annual deductible, and apply to most services. Use CareSource24 Call the CareSource24® Nurse Advice Line to make...

...savings” that lower the amount you have to pay for deductibles, copayments, and coinsurance. CSRs only apply to Silver plans†, so if you qualify for CSR and want to take...

...afford their copayment, you must still render services to the member and cannot turn away the member. Please visit the Member Billing Policy page for more information. Coordination of Benefits...

...Basic Copays may apply HIP Maternity HIP State Plus HIP State Basic Copays may apply Prior Authorization Needed? Doctor Visits Yes Yes Yes Yes Yes Most of these services do...

...Medicare plan to determine if they have Medicare Part D drug copays. Formulary Exceptions During the course of a member’s medical care, there may be instances when a member requires...

...are no copays for preventive care, family planning, emergencies or dialysis. Services with a copay include: Service Copays and Exceptions Outpatient service $3 for all non-emergency hospital visits. Inpatient services...