Co-Pays

amercy

We are looking to increase are copays from 10/0/50/0 to 20/500/75/200 in order to cut some cost. What kind of copays do you have?

Thanks,
A~

HRinFL

$20.00 co-pay to PCP
$40.00 co-pay for Specialists (no referral needed)

80/20, with a $250.00 deductible with a $1250.00 out of pocket max per year.

POPEYE

$25 PCP
$35 Specialist - No referral needed

80/20 Split

No deductible - $1000 individual $2000 family yearly out of pocket

Hunter1

Apparently some Forumites understand what you mean, but what do the 10/0/50/0, etc. mean?

amercy

No Problem

$10 Dr visit copay
$0 Hospital copay
$50 Emergency room copay
$0 Outpatient surgery copay

A~

TN HR

amercy, mercy! You have a rich plan! Ours is:

No deductible, no % split.

General Practitioner: $10
Specialist: $20
ER: 100 (waived if admitted)
Inpatient Hospital: $250
Outpatient Hospital: $150

Hunter1

Thanks. Using your shorthand, ours is also 10/0/50/0. (That's in-network) We do have 90/10 coinsurance in-network, 70/30 out-of-network, and very low deductibles of $100S/$300F. Also a rich plan in the public sector.

atrimble

In Network: (POS)
Copays: PCP:$15, Spec $30, ER: $100 (waived on admit), Urgent care: $25, Lab/X-ray: $30, RX: $8/20/35
No annual deductible, no max
Coinsurance: 100%, no max
Ambulance: $50; Substance Abuse: $50/day inpatient, $30 outpatient

Out of Network:
Max $1M
Annual Deduct: $1K indiv./$3K fam
Coinsurance: 70%
Coinsurance max: $3K indiv., $9K fam

-Abby

KathyHR

Here's ours (in-network):

Doctor: $15
Hospital: 20% after deductible of $250 individual
Emergency Room: $100, waived if admitted
Outpatient: 20% after deductible
Out of pocket maximum: $1,500 individual

We have a 90/10 split. I was looking into changing it to 80/20, but since raises are a big ? I'm looking at only 85/15 for next year.

dbutton111

We have a core plan and a buy up plan.

Benefits under the core plan are:

$30 office visit
$0 hospital (20% coinsurance after $1000 deductible)
$100 emergency room
$50 urgent care

Benefits under the buy up plan are:

$20 office visit
$0 hospital (10% coinsurance after $250 deductible)
$50 emergency room
$35 urgent care

Gloria

Our PPO plan has in-net deductibles of $150 for an individual and $300 for family. Out-net deductibles are $300 for an individual and $600 for family.

In-net coinsurance (excluding the deductibles) is 90/10. The out-net coinsurance (excluding deductibles) is 70/30.

General office visits are $25.00. Hospital emergency visits are $50 per visit, but waived if admitted.

Our presciption benefits offers copays of $5.00 for generic, $20.00 for brand names and $35.00 for non-formularies if purchased through a local pharmacy. The mail order copays for a three month supply are $10/$40/$70. However, we allow two annual fills for maintenance drugs purchased through the pharmacy at the regular copays listed above. If the third fill of a maintenance drug (medication that must be taken on a regular basis) is purchased through the local pharmacy, the member will be charged the mail order copays ($10/$40/$75) for a 30 day supply.


G

Gloria

I made a correction in the last paragraph. Third fills for maintenance drugs purchased through local pharmacist are ($10/$40/$70)

G

>Our PPO plan has in-net deductibles of $150 for
>an individual and $300 for family. Out-net
>deductibles are $300 for an individual and $600
>for family.
>
>In-net coinsurance (excluding the deductibles)
>is 90/10. The out-net coinsurance (excluding
>deductibles) is 70/30.
>
>General office visits are $25.00. Hospital
>emergency visits are $50 per visit, but waived
>if admitted.
>
>Our presciption benefits offers copays of $5.00
>for generic, $20.00 for brand names and $35.00
>for non-formularies if purchased through a local
>pharmacy. The mail order copays for a three
>month supply are $10/$40/$70. However, we allow
>two annual fills for maintenance drugs purchased
>through the pharmacy at the regular copays
>listed above. If the third fill of a
>maintenance drug (medication that must be taken
>on a regular basis) is purchased through the
>local pharmacy, the member will be charged the
>mail order copays ($10/$40/$70) for a 30 day
>supply.
>
>
>G
>