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Client copayments (OHP Plus and OHP with Limited Drug only) Other client FAQs: Benefits • Enrollment •Rights • Premiums • Copayments Do I have to make copayments? Are my children subject to copayments? Which services are exempt from copayments? Which services are subject to copayments? Which dental services covered by the OHP Plus or OHP with Limited Drug benefit package have a copayment? How much are these copayments? Are copayments charged per procedure, per visit, per day, per provider, etc.? Who will collect my copayment if one is required, and when will it be collected? What happens if I do not pay the copayment? Can my provider refuse to serve me if I do not pay a copayment? What happens when I seek services from a provider who has not been authorized by my managed care plan to give me care? Q. Do I have to make copayments? Are my children subject to copayments? A. Children under age 19 do not have copayments. The OHP Standard benefit package does not have copayments. The OHP Plus and OHP with Limited Drug benefit packages do have copayments for specific outpatient services and prescription drugs for some adults. Each provider will know if a copayment is required and how much to charge. (The OMAP Medical Care Identification shows the benefit package and the copayment information for each member of the household.) Some adults are exempt from copayments. Copayments are not charged to adults who are:
Q. Which services are exempt from copayments? A. For the OHP Plus and OHP with Limited Drug benefit packages, copayments are not charged for the following:
The OHP Standard benefit package does not have copayments. Back to top Q. Which services are subject to copayments? A. For the OHP Plus or OHP with Limited Drug benefit packages, copayments are charged for certain types of outpatient services. There are exceptions, as noted in other answers. Your provider will know which services are subject to a copayment and how much to charge. Your provider may charge $3 per visit per day. You may be charged a copayment when you get the following services:
The OHP Standard benefit package does not have copayments. Back to top Q. Which dental services covered by the OHP Plus or OHP with Limited Drug benefit packages have a copayment? How much are these copayments? A. The OHP Plus and OHP with Limited Drug benefit packages have a $3 copayment for restorative dental services. Diagnostic dental services do not have a copayment. Diagnostic services include oral examinations to identify changes in your health or dental status. They also include routine cleanings, x-rays, lab work and tests needed to make a diagnosis or treatment decision. The OHP Standard benefit package does not have copayments. Back to top Q. Are copayments charged per procedure, per visit, per day, per provider, etc.? A. Your provider may charge only one copayment per visit per day for services covered under the OHP Plu or OHP with Limited Drug benefit packages. The OHP Standard benefit package does not have copayments. Back to top Q. Who will collect my copayment if one is required, and when will it be collected? A. Your provider will collect your copayment. The provider may collect it at the time of service or during the regular billing cycle. The amount charged is based on the service you get. The OHP Standard benefit package does not have copayments. Back to top Q. What happens if I do not pay the copayment? A. If you do not pay the copayment, you should see the provider’s billing clerk. You can discuss the situation and options. You might be able to set a repayment schedule. Only your provider can waive the copayment. However, your provider also may turn your debt over to a collection agency. The OHP Standard benefit package does not have a copayment. Back to top Q. Can my provider refuse to serve me if I do not pay the copayment? A. Your provider cannot deny you service only because you do not pay a copayment. The OHP Standard benefit package does not have a copayment. Back to top Q. What happens when I seek services from a provider who has not been authorized by my managed care plan to give me care? A. Your managed care plan approves your services. Your plan does not have to pay a provider for care it has not approved. This is true even if the provider collected your copayment. Your provider should check your OMAP Medical Care Identification before serving you. This includes making a note of your benefit package and managed care plan. Back to top This page updated Sept. 2006. |
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