Copayment Information.

The WVCHIP Plan has two levels of copayment participation*. Members under Group A have copayments for brand name prescription drugs only. Members under Group B have copayments for prescription drugs and for some medical and other health services.

Group A

Members in this group receive insurance cards marked “Drug CoPays Only.” Copayments are required for prescription drugs according to the following schedule:

Drugs
(1-34 Day Supply)
Amount Type
$0 Generic
$5 Listed Brand Drugs
Not Covered Non-Listed Brand Drugs

Group B

Members in this group receive insurance cards marked “CoPays Apply.” Copayments apply to prescription drugs and some medical services under the following schedules:

DRUGS
MEDICAL SERVICES
Copayment Type Copayment Type
$0 Generic $15 Physician Visit for Illness
$10 Listed Brand Drugs $25 Hospital/Inpatient Services
Not Covered Non-Listed Drugs $25 Outpatient Services(per procedure)
  $35 Emergency Room(waived if admitted)
No copayments apply for preventive services such as well-baby and well-child check-ups, immunizations, and dental and vision preventive check-ups.

Copayment Maximums

The maximum copayment amounts that may be required during a benefit year.
Prescription Drug Maximums Medical Services Maximums
$100 maximum per 1 child $150 maximum per 1 child
$200 maximum per 2 children $300 maximum per 2 children
$300 maximum for 3 or more children $450 maximum for 3 or more children

Total Maximum Copayments: $750 per benefit plan year

*Federal regulation permits the exemption of Native American/Alaskans from copayments. Click here for a list of federally recognized tribes.

Click here for the WVCHIP Drug Formulary (p.d.f.).

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