You may understand the term copay to mean the part of your medical expense for which you are responsible. This is true. Copay differs from coinsurance in that it is a flat fee as opposed to a percentage of the contractual service fee. Your policy schedule will detail the copay amount for each service.

For example, if your plan requires a $25 copay per office visit, you are responsible for paying $25 for a trip to a covered physician. So, if the total contractual fee for a routine office visit for a covered provider is $90, you are responsible for $25 and your health insurance plan covers the remainder. Other services subject to copays include, but not limited to, prescription drugs, hospitalizations and ER visits. Copay amounts are typically more for providers who are not within your plan’s network. Be advised that any additional treatments or lab work may be an additional out of pocket expense and will be billed separately.