All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.
Visiting a Health Care Provider's Office or Clinic
When you visit a health care provider for a primary care visit to treat an injury or illness, you will pay 20% coinsurance if the provider is in-network. If the provider is out-of-network, you will pay 40% coinsurance. Telehealth visits have a $10 copayment and are subject to the deductible.
For specialist visits, the cost-sharing is the same: 20% coinsurance for in-network providers and 40% coinsurance for out-of-network providers.
Preventive care, screenings, and immunizations do not incur any charge for in-network services, and the deductible does not apply. However, these services are not covered out-of-network. You may have to pay for services that aren't classified as preventive. Confirm with your provider if the services needed are preventive and then check what your plan will cover.
Diagnostic Tests and Imaging
For diagnostic tests such as X-rays or blood work, you will pay 20% coinsurance for in-network services and 40% coinsurance for out-of-network services.
For imaging services like CT/PET scans or MRIs, the cost is 20% coinsurance if done by an in-network provider and 40% coinsurance for out-of-network providers.