Low copayments — or none at all.
Some FHPlus members are required to make copayments when receiving certain medical care and services. Others do not have to make these payments. See the following list of services that require copayments and information about who does not have to make copayments. If you have questions, please call Customer Service at 1-800-447-8255 or the Department of Health's FHPlus information line at 1-877-934-7587. If you have a pharmacy benefit question, please call the HIP Pharmacy Customer Service line at 1-888-447-7364, Monday through Friday, 8 am to 6 pm.
| Services | Copay |
|---|---|
| Generic Prescription Drugs | $3.00 for each prescription & refill |
| Brand Name Prescription Drugs | $6.00 for each prescription & refill |
| Clinic Visits | $5.00 per visit |
| Physician Office Visits | $5.00 per visit |
| Dental Visits | $5.00 per visit up to $25.00/year |
| Lab Services | $0.50 per test |
| Radiology Services (like diagnostic X-rays, ultrasound, nuclear medicine, and oncology services) | $1.00 per service |
| Inpatient Hospital Stay | $25.00 per stay |
| Non-Urgent Emergency Room Visit | $3.00 per visit |
| Over-the-Counter (OTC) Drugs (e.g., smoking cessation products, insulin) | $0.50 per item |
| Medical Supplies (e.g., hearing aid batteries, enteral formula, diabetes test strips, lancets and syringes) | $1.00 per item |
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Services For Which Copayments DO NOT Apply
- Emergency room visits for needed emergency care
- Family planning services, drugs and supplies
- Mental health clinic visits
- Chemical dependency clinic visits
- Drugs to treat mental illness (psychotropic)
- Drugs to treat tuberculosis
- Prescription drugs for residents of Adult Care Facilities
Members Who Do Not Have to Make Copayments
- Children under age 21
- Pregnant women (through 60 days postpartum)
- Permanent residents of nursing homes
- Residents of community-based residential facilities licensed by the Office of Mental Health or the Office of People with Developmental Disability
- Members who are financially unable to make copayments at any time and tell the provider that they are unable to pay
You will not be denied health care services if you are not able to pay the copayment at the time of service. However, you will still owe the unpaid copay to the provider and the provider may bill you or take other action to collect the owed amount.
If you have any questions about your benefits, call Customer Service at 1-800-447-8255.