Sometimes you will have to pay to get health care services. Preventive care is care that helps you stay well, like checkups, shots, pregnancy care, and childbirth. This kind of care is always free. You don’t have copays for preventive care.

For other care like hospital stays or sick child visits, you may have to pay part of the cost. Copays are what you pay for each health care service you get.

Not everyone in Vital Plan has copays. Your ID card will tell you if you have copays and what they are. Copays depend on the type of Vital Plan you have. Your ID card says what type of Vital Plan you have.

None of your doctors or providers can refuse to give you medically necessary services because you don’t pay your copays. But, your Insurer and your providers can take steps to collect any copays you owe.

You should only have to pay your copay for your care. You should not be billed for the rest of the cost of your care. If you are billed for the rest of the cost, you can appeal. Look here to find out what to do if you get a bill for your care.

COPAY CHARTS

Do you have to pay copays for a PCP, Specialist, ER visit, hospital stay, or other type of service? Not sure? Check the chart below, look at your ID card or call your Insurer at 1-844-336-3331 (toll free), TTY 787-999-4411 (for the hearing impaired). 

• No copayments can be charged to the Federal and CHIP population for the treatment of any Emergency Medical Condition or Psychiatric Emergency;
• No Co-Payments shall be charged for Medicaid and CHIP children under eighteen (18) years under any circumstances;
• By using Vital Plan Medical  Consultation Line the Enrollee may avoid a Co-Payment for such services
  
  

* Copays apply to diagnostic tests only.  Copays do not apply to tests required as part of a preventive service.
** Copays apply to each medicine included in the same prescription pad.