Often used with group health insurance policies. The copay provision states what percentage of a claim the company will pay and what percentage the insured will pay. For example, a 90 per cent copay provision would provide that the insurer pay 90 percent of claims and the insured pay 10 per cent.
Insurance Encyclopedia
Copay, Health
This is an agreement where the covered person pays a specified amount for various services and the health care provides pays the remainder. The covered person usually must pay his or her share when the service is rendered. Similar to co-insurance, except that coinsurance is usually a percentage of certain charges where the co-payment is a rupee amount.
Copayment
See: “Copay, Health.”
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A fixed fee the insured pays for services in addition to what the insurance company will pay.
Copayment (copay)
1. Specific dollar amount to be collected when services are received. For example, the patient might pay out of pocket $10 for each prescription received and the plan would pay the remaining cost of the drug. This cost-sharing arrangement is sometimes referred to as coinsurance and deductible, cooperative payment, and cost sharing. However, coinsurance has a slightly different meaning under some programs (see coinsurance). 2. Under the Medicare program, it is considered fraud to routinely waiver copayments and deductibles, regardless of need. 3. In the Medicaid program, a dollar amount that an individual must pay at each office visit for receiving medical and child care services. Different copayment amounts may be set for each patient type and certain medical procedures. Child care copayments are based on gross annual income, number in the home, and number needing child care. Note: If a health plan integrates the copayment into the membership fee, then do not collect copays from the patients (members) of the plan.
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