Merritt Personal Lines Manual: HMO Co-Payments

Many HMOs and other managed care plans require members to make a co-payment when they get treatment. A co-payment is a specific dollar amount or percentage of the cost of a service that the insured must pay in order to receive a basic health care service.

Co-payments are rarely more than $20 -- but they are due every time the insured visits a health care provider.

Example: the insured may be required to pay a $15 co-payment for an office visit to a physician or the insured might be required to pay a 30 percent co-payment (30 percent of the cost of the services) for alcohol and drug rehabilitation.

Some HMOs don't require any co-payment for a considerable number of their services. Co-payments for alcohol and drug rehabilitation and services for mental and emotional disorders are usually expressed as a percentage of the cost of the service and are therefore more costly to the member. Co-payments for supplemental services are often considerably more than for basic services.