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In insurance, a fee that a policyholder must pay for certain covered items for which the insurance company otherwise pays. For example, a check-up with a doctor may cost the policyholder a copayment of $25, with the insurance company paying for the remainder of the cost due. A copayment is also called a co-pay and should not be confused with a deductible. It exists to discourage policyholders from abusing the insurance policy.


If you have a managed-care health insurance plan, your copayment is the fixed amount you pay -- often $10 to $25 -- for each in-network doctor's office visit or approved medical treatment

In some plans, the copayment to see a specialist to whom you're referred is higher than the copayment to visit your primary care physician. Some plans may not require copayments for annual physicals and certain diagnostic tests.

If you see an out-of-network provider, you are likely to be responsible for a percentage of the approved charge, called coinsurance, plus any amount above the approved charge.

References in periodicals archive ?
On Tuesday, the PM denied there will be such copay while the Minister made statements earlier Wednesday the copay still stands and it was announced in the early afternoon Borisov has accepted her resignation.
Collecting copays and deductibles is essential in today's tight healthcare environment.
Eliminating or reducing copays on employees' prescription drugs are the latest attempts by employers to curb health-care costs.
Before that happens, however, plans offering three-tiered copays will need to do a better job of educating patients about how the system works, according to Judith Cahill, executive director of the Academy of Managed Care Pharmacy, an Alexandria, Va.
On Monday, it was announced that the Health Ministry's "Concept for better health care 2010 - 2015" is planning changes, which envision that patients should copay for treatment in hospitals.
The up-front copays were removed from traditional PPO plans, and in their place consumers were given HSAs to help pay for routine expenses with tax-free dollars.
Express Scripts' Zero Dollar Copay program is an innovative solution to help plan sponsors and their members take advantage of the cost savings associated with generic drugs," maintains PBMI president Michael Deskin.
The first tier features the lowest copay with brand and generic drugs; the second tier has more expensive brand-name drugs and generics; the third tier is primarily brands with lower-cost equivalent drugs in the first two tiers and has a higher copay; and the fourth tier is reserved for fewer than 1% of all drugs prescribed, such as biotech and new drugs on the market.
With a percentage copay, as the costs of drugs continue to rise, the plan could keep things under control," she said.
For example, for a $120 office visit (office fee), an insurance company's agreed-to-pay amount might be $100, minus a $10 copay.