This online publication has been updated to include the Amendments through January 1, 2014. For details such as the effective dates of amendments, see your group-specific amendments in the Publications & Forms section of this site.

1. Empire Plan Ambulance Copay
2. Ambulance Copayment Ontario
3. Ambulance Company Va
4. Kaiser Ambulance Copay 2019
5. Ambulance Copy Paste

Services by Empire Plan Participating Providers

You pay only your copayment when you choose Empire Plan Participating Providers for covered services. Check your directory for Participating Providers in your geographic area, or ask your provider. For Empire Plan Participating Providers in other areas and to check a provider's current status, call The Empire Plan toll-free at 1-877-7-NYSHIP (1-877-769-7447) and choose UnitedHealthcare or use the online Participating Provider Directory.

Office Visit - $20

Ambulance called), as this is not a covered procedure. Nonambulance transportation services billed with revenue code 0540 (ambulance general classification). Ambulance mileage (or ambulance mileage when reported with response and treatment only) if an ambulance transport code has not been billed for the same date of service or has been. An ambulance service provider that operates under the direction of municipality may not, without an insurer’s knowledge, waive co-payments, co-insurance, or deductibles for the non-Medicare recipients that live in the municipality, because such a waiver may constitute insurance fraud.

Office Surgery - $20

(If there are both an Office Visit charge and an Office Surgery charge by a Participating Provider in a single visit, only one copayment will apply, in addition to any copayment due for Radiology/Laboratory Tests.)

Radiology, Single or Series; Diagnostic Laboratory Tests - $20

(If Outpatient Radiology and Outpatient Diagnostic Laboratory Tests are charged by a Participating Provider during a single visit, only one copayment will apply, in addition to any copayment due for Office Visit/Office Surgery.)

Routine Mammography Screening: - No copayment

Adult Immunizations for Herpes Zoster (Shingles) immunization for enrollees age 55 and over but under age 60 - Paid-in-full benefit for covered adult immunizations as recommended by the Advisory Committee on Immunization Practices of the Centers of Disease Control and Prevention when received from a participating provider.

Allergen Immunotherapy - No copayment

Well-Child Office Visit, including Routine Pediatric Immunizations - No copayment

Prenatal Visits and Six-Week Check-Up after Delivery - No copayment

Chemotherapy, Radiation Therapy, Dialysis - No copayment

Authorized care at Infertility Center of Excellence - No copayment

Hospital-based Cardiac Rehabilitation Center - No copayment

Anesthesiology, Radiology, Pathology in connection with inpatient or outpatient network hospital services - No copayment

Free-standing Cardiac Rehabilitation Center visit - $20 Copayment

Urgent Care Center - $20 Copayment

Convenience Care Clinic Visit - $20 Copayment

Contraceptive Drugs and Devices when dispensed in a doctor's office - $20 Copayment*
(in addition to any copayment(s) due for Office Visit/Office Surgery and Radiology/Laboratory Tests)

*Copayment waived for preventive services under the federal Patient Protection and Affordable Care Act (PPACA). See NYSHIP Online for details. Diagnostic services require Plan copayment or coinsurance.

Outpatient Surgical Locations (including Anesthesiology and same-day pre-operative testing done at the center) - $30

Medically appropriate professional ambulance transportation - $35 Charge

Chiropractic Treatment or Physical Therapy Services by Managed Physical Network (MPN) Providers

You pay only your copayment when you choose MPN network providers for covered services. To find an MPN network provider, ask the provider directly, or call UnitedHealthcare at 1-877-7-NYSHIP (1-877-769-7447) toll free. Internet: https://www.cs.ny.gov.

Office Visit - $20 Copayment

Radiology; Diagnostic Laboratory Tests - $20 Copayment (If Radiology and Laboratory Tests are charged by an MPN network provider during a single visit, only one copayment will apply, in addition to any copayment due for Office Visit.)

Hospital Outpatient Department Services

Emergency Care - $60 Copayment*
(The $60 hospital outpatient copayment covers use of the facility for Emergency Room Care, including services of the attending emergency room physician and providers who administer or interpret radiological exams, laboratory tests, electrocardiogram and pathology services.)

Network Hospital Outpatient Department Services

Surgery - $40 Copayment*

Diagnostic Laboratory Tests - $30 Copayment*

Diagnostic Radiology (including mammography, according to guidelines) - $30 Copayment*

Administration of Desferal for Cooley's Anemia - $30 Copayment*

Physical Therapy (following related surgery or hospitalization) - $20 Copayment Facebook video calling for mac download.

Chemotherapy, Radiation Therapy, Dialysis - No copayment

Pre-Admission Testing/Pre-Surgical Testing prior to inpatient admission - No copayment

*Only one copayment ($40 copayment if surgery is included; $30 copayment if diagnostic outpatient services only) per visit will apply for all covered hospital outpatient services rendered during that visit. The copayment covers the outpatient facility. Provider services may be billed separately. You will not have to pay the facility copayment if you are treated in the outpatient department of a hospital and it becomes necessary for the hospital to admit you, at that time, as an inpatient.

Be sure to follow Benefits Management Program requirements for hospital admissions, skilled nursing facility admission and Magnetic Resonance Imaging (MRI), Magnetic Resonance Angiography (MRA). Computerized Tomography (CT), Positron Emission Tomography (PET) scan or Nuclear Medicine tests.

Mental Health and Substance Abuse Services by Network Providers When You Are Referred by Beacon Health Options

Call The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) toll free before beginning treatment.

Visit to Outpatient Substance Abuse Treatment Program - $20 Copayment

Visit to Mental Health Professional - $20 Copayment

Emergency Room Care - $60 Copayment

Psychiatric Second Opinion when Pre-Certified - No copayment

Mental Health Crisis Intervention (three visits) - No copayment

Inpatient - No copayment

Empire Plan Prescription Drugs*

Note: Medicare-primary enrollees or dependents should refer to the Empire Plan Medicare Rx Evidence of Coverage for prescription copayment amounts

(Only one copayment applies for up to a 90-day supply.)

Up to a 30-day supply from a network pharmacy or through the Mail Service Pharmacy or the Designated Specialty Pharmacy

$5 Copayment – Generic Drugs or Level 1 Drugs
$25 Copayment – Preferred Brand-name Drugs, Compound Drugs or Level 2 Drugs
$45 Copayment – Non-preferred Brand-name Drugs or Level 3 Drugs**

31 to 90-day supply from a network pharmacy

$10 Copayment – Generic Drugs or Level 1 Drugs
$50 Copayment – Preferred Brand-name Drugs, Compound Drugs or Level 2 Drugs
$90 Copayment – Non-preferred Brand-name Drugs or Level 3 Drugs** Vst converter for mac.

31 to 90-day supply through the Mail Service Pharmacy

$5 Copayment – Generic Drugs or Level 1 Drugs
$50 Copayment – Preferred Brand-name Drugs, Compound Drugs or Level 2 Drugs
$90 Copayment – Non-preferred Brand-name Drugs or Level 3 Drugs**

*Note: Oral chemotherapy drugs for the treatment of cancer do not require a copayment and covered services defined as preventive under the Patient Protection and Affordable Care Act are not subject to copayment.
**If you choose to purchase a brand-name drug that has a generic equivalent, you pay the non-preferred brand-name copayment plus the difference in cost between the brand-name drug and its generic equivalent (with some exceptions), not to exceed the full cost of the drug.

Copayments

Medical Debt Relief

American Rescue Plan: Copayment Cancellations and Refunds

Due to the passage of the American Rescue Plan in March 2021, copayments for medical care and prescriptions provided by the Veterans Health Administration (VHA) during the period of April 6, 2020 through September 30, 2021 will be canceled. All copayments paid to VA for medical care and prescriptions during the period of April 6, 2020 to present will be refunded.

Please review the COVID-19 Medical Debt Relief page for answers to some common questions.
COVID-19 Medical Debt Relief FAQs

Enrolled Veterans will be assessed copayments for care or services (including urgent care) based on their eligibility and/or income on file in the VA health care system. For care or services furnished through the Veterans Community Care Program, the same copayment requirements will apply. Copayment rates are listed below.

For information on how to pay your bill or copayment, visit our Billing and Payments page.
Billing and Payments

Veteran Copayments— Published October 6, 2017

You can explore your eligibility for VA health care benefits using the online Health Benefits Explorer or by contacting the VA Call Center.

VA Call Center: 877-222-VETS (8387)
Monday through Friday, 8:00 a.m. – 8:00 p.m. ET

Urgent Care (Community Care)

Veterans may be charged a copayment for urgent care that is different from other VA medical copayments.

• Copayments depend on the Veteran’s assigned priority group and the number of times an urgent care provider is visited in a calendar year.
• Copayment charges are billed separately by VA as part of VA’s billing process. There is no limit to the number of times a Veteran can go to an urgent care provider. For more information, visit the OCC Urgent Care page.
  OCC Urgent Care page

Outpatient Care

Outpatient care is defined as primary or specialty care that does not require an overnight stay. Copayments for outpatient care are listed in the table.

NOTE: Veterans who have a service-connected rating of 10% or higher are not required to pay a copayment for outpatient medical care.

Inpatient Care

Inpatient care occurs when a patient’s condition requires admission to a hospital. There are two inpatient copayment rates: the full rate and the reduced rate. Veterans living in high cost areas may qualify for a reduced inpatient copayment rate. Copayment rates for an inpatient hospital stay are listed in the table below.

NOTE: Veterans who have a service-connected disability rating of 10% or higher are not required to pay a copayment for inpatient medical care.

Medications

Medication copayments are required for each prescription, including each 30-day (or less) supply of maintenance medications prescribed on an outpatient basis for nonservice-connected conditions. This copayment may change annually.

Medication copayments are also charged for all over-the-counter (OTC) medications (like aspirin, cough syrup, and vitamins) that are dispensed from a VA pharmacy. You may want to consider purchasing over-the-counter medications on your own.

NOTE: There is an annual medication copayment cap of $700 for Veterans in Priority Groups 2 through 8. The medication copayment cap goes by calendar year (January 1 – December 31).

Veterans who have a service-connected rating of 40% or less, and whose income is at or below the applicable national income thresholds may wish to complete a medication copayment exemption test.

VA National Income LimitsVA Financial Assessment information

Additional information on tiered medication copays can be found on the VA Pharmacy Benefits Management Services website.

Geriatrics and Extended Care

Empire Plan Ambulance Copay

Copayments for health care for older Veterans are based on three levels of care—inpatient, outpatient, and domiciliary (see below). Copayment rates will vary from Veteran to Veteran depending upon financial information submitted on VA Form 10-10EC, Application for Extended Care Services.

NOTE: Copayments for long-term care services start on the 22^nd day of care during any 12-month period. There is no copayment requirement for the first 21 days.

Ambulance Copayment Ontario

Resources

Ambulance Company Va

877-222-VETS (8387)
Monday – Friday
8 a.m. – 8 p.m. EST

Kaiser Ambulance Copay 2019

VA Geriatrics and Extended Care Resources

Ambulance Copy Paste

• VA Geriatrics and Extended Care
• VA Community Living Centers
• Respite Care
• Adult Day Health Care
• Domiciliary Care for Homeless Veterans Program