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No copayment. Hospital - Inpatient Full coverage.
Copayment $3 per day with a $75 cap per stay. Hospital - Outpatient Full coverage.
Copayment $3 per visit. Hospital - Outpatient Emergency Room Full coverage.
No copayment. Mental Health and Substance Abuse Treatment Full coverage (not including room and board).
Copayment $.50 to $3 per visit (limited to the first 15 hours or $500 of services, whichever comes first, provided per calendar year).
Copayment not required when services are provided in a hospital setting or for residential substance use disorder treatment services. Nursing Home Full coverage.
No copayment.
Physical Therapy (PT), Occupational Therapy (OT) and Speech Therapy (ST) Full coverage.
C-payment $.50 to $3 per provider, per date of service.