Copayment Requirements
Body
Revision 18-4; Effective October 1, 2018
CHIP
Households are required to pay copayments for medical services or prescription drugs at the time of the service. The applicable copayment requirements are:
Coverage Description At or below 151% FPIL Above 151% up to and including 186% FPIL Above 186% up to and including 201% FPIL Preventative health care and shots $0 $0 $0 Non-emergency ER visit $5 $75 $75 Generic prescription $0 $10 $10 Name-brand prescription $5 $35 $35 Inpatient hospital care (per admission) $35 $75 $125 Outpatient hospital care $0 $0 $0 Other doctor visits $5 $20 $25