Copayments

Acute inpatient hospital services: $0 copay

• Per admission

Inpatient physician and surgeon services: $0 copay

• Cosmetic surgery isn’t covered (except postmastectomy reconstructive surgery) 

Transplant: $0 copay

• No limit

Emergency room (ER): $0 copay

• $0 copay for using the ER without an emergency

Emergency ambulance (ground or air): $0 copay

• No limit

Physician office services: $0 copay

• No limit

Outpatient hospital ambulatory surgical center: $0 copay

• Cosmetic surgery isn’t covered (except postmastectomy reconstructive surgery)

Rural Health Clinic (RHC), Federally Qualified Health Center (FQHC) and Primary Care Center (PCC): $0 copay

• Per visit 

Dental services: $0 copay for adults; $0 copay for children

• Per visit

Home health care: $0 copay

• No limit

Vision services: $0 copay for adults; $0 copay for children

• 1 exam per year

Urgent care: $0 copay

• Per visit

Radiation therapy: $0 copay

• No limit

Chemotherapy: $0 copay

• No limit

Family planning: $0 copay

• No limit

Podiatry: $0 copay

• No limit

Prenatal and postnatal care: $0 copay

• No limit

Maternity services: $0 copay

• No limit

Generic medications: $0 copay

• No limit

Brand-name medications: $0 copay

• No limit

Skilled nursing and rehabilitation: $0 copay

• No limit

Chiropractic services: $0 copay

• Per visit (limited to 26 visits per 12-month period)

Durable medical equipment: $0 copay

• Per item

Hearing aids and audiometric services: $0 copay

• Limited to children under 21

Orthotic and prosthetic devices: $0 copay

• Per item

Physical and occupational speech therapy: $0 copay for adults; $0 copay for children

• Per visit (limited to 20 visits for each therapy, per year)

Private duty nursing: $0 copay

• 2,000 hours per year (outpatient only)

Laboratory, diagnostic and radiology services (outpatient): $0 copay

• Per visit and per service

Autism spectrum disorder services: $0 copay

• Up to age 21

Early Periodic Screening Diagnosis and Treatment (EPSDT) special services: $0 copay

• Limited to medically necessary services and must get prior authorization

Commission for Children with Special Healthcare Needs: $0 copay

• Limited to children who meet the eligibility criteria of the Kentucky Commission for Children with Special Healthcare Needs

Specialized children’s services clinics: $0 copay

• Services are limited to children under age 18 and must be performed by specialized clinics

Targeted case management: severe emotional disability (SED) children services: $0 copay

• Limited to children who meet Kentucky’s statutory definition of SED. Services are available to children from birth.

First Steps services: $0 copay

• For children up to 2 years old who have physical or mental developmental delays

Targeted case management: $0 copay

• No limit

Inpatient mental health and substance use services: $0 copay

• Per admission

Outpatient mental health and substance use services: $0 copay

• Per visit

Psychiatric residential treatment facilities (PRTFs): $0 copay

• Services for residents ages 6 to 21

Smoking and tobacco cessation: $0 copay

• No limit

Allergy services: $0 copay

• No limit

Wellness and preventive health services: $0 copay

• No limit

Nonemergency transportation services: $0 copay

• No limit

Family planning services: $0 copay

• No limit

Hospice services: $0 copay

• No limit

Second opinion: $0 copay

• No limit

Telehealth: $0 copay

• No limit

Renal dialysis and hemodialysis services (outpatient): $0 copay

• No limit

Notes: 

• All benefits provided must be medically necessary.

• Copays apply to all members, unless they are exempt.

• Copays are limited to no more than 5% of your family’s total income every three months.