2025 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 4. Your Costs for Covered Services
Copayment
Section 4. Your Costs for Covered Services
Copayment
Copayment
A copayment is a fixed amount of money you pay to the provider, facility, pharmacy, etc., when you receive certain services.
Example: If you have Standard Option when you see your Preferred physician, you pay a copayment of $30 for the office visit, and we then pay the remainder of the amount we allow for the office visit. (You may have to pay separately for other services you receive while in the physician’s office.) When you go into a Preferred hospital, you pay a copayment of $350 per admission. We then pay the remainder of the amount we allow for the covered services you receive.
Copayments do not apply to services and supplies that are subject to a deductible and/or coinsurance amount.
Note: If the billed amount (or the Plan allowance that providers we contract with have agreed to accept as payment in full) is less than your copayment, you pay the lower amount.
Note: When multiple copayment services are performed by the same professional or facility provider on the same day, only one copayment applies per provider per day. When the copayment amounts are different, the highest copayment is applicable. You may be responsible for a separate copayment for some services.
Example: If you have Basic Option when you visit the outpatient department of a Preferred hospital for non-emergency treatment services, your copayment is typically $250. If you also receive an ultrasound in the outpatient department of the same hospital on the same day, you will not be responsible for the $40 copayment typically applied to the ultrasound.
A copayment is a fixed amount of money you pay to the provider, facility, pharmacy, etc., when you receive certain services.
Example: If you have Standard Option when you see your Preferred physician, you pay a copayment of $30 for the office visit, and we then pay the remainder of the amount we allow for the office visit. (You may have to pay separately for other services you receive while in the physician’s office.) When you go into a Preferred hospital, you pay a copayment of $350 per admission. We then pay the remainder of the amount we allow for the covered services you receive.
Copayments do not apply to services and supplies that are subject to a deductible and/or coinsurance amount.
Note: If the billed amount (or the Plan allowance that providers we contract with have agreed to accept as payment in full) is less than your copayment, you pay the lower amount.
Note: When multiple copayment services are performed by the same professional or facility provider on the same day, only one copayment applies per provider per day. When the copayment amounts are different, the highest copayment is applicable. You may be responsible for a separate copayment for some services.
Example: If you have Basic Option when you visit the outpatient department of a Preferred hospital for non-emergency treatment services, your copayment is typically $250. If you also receive an ultrasound in the outpatient department of the same hospital on the same day, you will not be responsible for the $40 copayment typically applied to the ultrasound.