320 COPAYMENTS

320.1 The following copayments shall be due for enrollees at the time of service: A. For families with income, at the time of eligibility determination, less than 101% of the Federal Poverty Level (MAGI-equivalent), all copayments shall be waived, except for emergency and care, which shall be $3.00 per use and urgent/after hours care, which shall be $1.00 per use. B. For families with income, at the time of eligibility determination, between 101% and 150% of the Federal Poverty Level (MAGI-equivalent), the copayment shall be: 1. Effective July 1, 2012: a. $2.00 per office visit; b. $2.00 per outpatient mental health or substance abuse visit; c. $1.00 per generic or brand name prescription; d. $2.00 per physical therapy, occupational therapy or speech therapy visit; e. $2.00 per vision visit; f. $3.00 per use of emergency care (co-payment is waived if client is admitted to the hospital); g. $1.00 per use of urgent/after hours care; h. $2.00 per trip for emergency transport/ambulance services; i. $2.00 per inpatient hospital visit; j. $2.00 per inpatient hospital visit for physician services in the hospital; k. $2.00 per outpatient hospital or ambulatory surgery center visit. C. For families with income, at the time of eligibility determination, between 151% and 200% of Federal Poverty Level (MAGI-equivalent), the copayment shall be: 1. Effective July 1, 2012: a. $5.00 per office visit; b. $5.00 per outpatient mental health or substance abuse visit; c. $3.00 per generic prescription; d. $10.00 per brand name prescription; e. $5.00 per physical therapy, occupational therapy or speech therapy visit; f. $5.00 per vision visit; g. $30.00 per use of emergency care ((co-payment is waived if client is admitted to the hospital) h. $20.00 per use of urgent/after hours care; i. $5.00 per date of service for laboratory and radiology/imaging services j. $15.00 per trip for emergency transport/ambulance services; k. $20.00 per inpatient hospital visit; l. $5.00 per inpatient hospital visit for physician services; m. $5.00 per outpatient hospital or ambulatory surgery center visit. 3. Due to the Coronavirus COVID-19 Public Health Emergency, members who are eligible for Children’s Basic Health Plan will have waived laboratory copayments, specifically as it relates to laboratory copayments associated with COVID-19 testing. Copayments will continue to be waived after May 11,2023 the ending of Coronavirus COVID-19 Public Health Emergency. D. For families with income, at the time of eligibility determination, between 201% and 260% of Federal Poverty Level (MAGI-equivalent), the copayment shall be: 1. Effective July 1, 2012: a. $10.00 per office visit; b. $10.00 per outpatient mental health or substance abuse visit; c. $5.00 per generic prescription; d. $15.00 per brand name prescription; e. $10.00 per physical therapy, occupational therapy or speech therapy visit; f. $10.00 per vision visit; g. $50.00 per use of emergency care (co-payment is waived if client is admitted to the hospital); h. $30.00 per use of urgent/after hours care; i. $10.00 per date of service for laboratory and radiology/imaging services j. $25.00 per trip for emergency transport/ambulance services; k. $50.00 per inpatient hospital visit; l. $10.00 per inpatient hospital visit for physician services; m. $10.00 per outpatient hospital or ambulatory surgery center visit. 3. Due to the Coronavirus COVID-19 Public Health Emergency, members who are eligible for Children’s Basic Health Plan will have waived laboratory copayments, specifically as it relates to laboratory copayments associated with COVID-19 testing. Copayments will continue to be waived after May 11,2023 the ending of Coronavirus COVID-19 Public Health Emergency.