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  Beneficiary Copayment Amounts 

Some adults may have to pay a small co-payment for some services.
Call 1-888-549-0820 if you have questions about which services require a co-payment.

You can only be required to pay for:

  • Allowed co-payments
  • Services that are not covered
  • Services for which you have already used the limit allowed

The following beneficiaries do not have co-payment requirements:

  • Children under 19 years of age
  • Pregnant women
  • Institutionalized individuals (such as persons in a nursing facility or ICF-MR)
  • Members of a Federally Recognized Indian Tribe (for services rendered by the Catawbas Service Unit in Rock Hill, SC and when referred to a specialist or other medical provider by the Catawba Service Unit)
  • Members of the Health Opportunity Account (HOA) program
The following services are not subject to a co-payment:

  • Medical equipment and supplies provided by DHEC
  • Orthodontic services provided by DHEC
  • Family planning services
  • End Stage Renal Disease (ESRD) services
  • Infusion Center services
  • Emergency services in the hospital emergency room
  • Hospice benefits
  • Waiver services
CURRENT COPAY AMOUNTS

$1.15
(per date of service)

$3.30
(per date of service)

$3.40
(per date of service)

$3.40
(per claim)

$25.00
(per admission)

Chiropractor Services

Doctor's office visits (Physician/Nurse Practitioner)

*Durable Medical Equipment and Supplies

Outpatient Hospital services
(non-emergency)

Inpatient Hospital  

Podiatrist services

Clinic Visits
(Federally Qualified Health Center(FQHC),
Rural Health Clinic (RHC),
Ambulatory Surgical Center)

Dental Services

 

 

 

Home Health visits

Prescriptions {per prescription/per refill}

 

 

 

Optometrist Services

 

 

 

 

Effective for dates of service on and after 07/11/11.
*NOTE: Durable Medical Equipment that is under a rent to purchase payment plan will have the $3.40 co-pay split evenly among the 10-month rental payment schedule.