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CHIP Copayments

If you get CHIP Perinatal benefits, you do not have cost-sharing obligations, including enrollment fees and copayments (copays). CHIP Members who are Native American or Alaskan Native also do not have cost-sharing obligations, including enrollment fees and copays.

How much are copays and when do they apply?

Your member's card shows if you have a copay. If you are a Native American or an Alaskan Native, then please call BCBSTX to have this copay amount corrected. You will not have to pay copays for the following:

  • Primary Care Provider (PCP) visits for well-baby and well-child services
  • Preventive services
  • Pregnancy-related assistance

The following chart shows your copay for different services, based on income guidelines.
 

Copays and Cost-Sharing
SERVICE At or below 151% FPL* Above 151% up to and including 186% FPL* Above 186% up to and including 201% FPL*
Enrollment Fee $0 $35 $50
Office visit $5 $20 $25
Non-emergency ER (per visit) $5 $75 $75
Emergency room (ER) $0 $0 $0
Facility Copay, Inpatient (per admission) $35 $75 $125
Generic drug $0 $10 $10
Brand drug $5 $35 $35
Cost-sharing cap (limit) 5% of family's income** 5% of family's income** 5% of family's income**

*The federal poverty level (FPL) refers to income guidelines established annually by the federal government.

** Per 12-month term of coverage.

 

If you have received a bill or paid out of pocket for a covered service, call the Customer Advocate Department. They can review your covered benefits with you and help you submit a claim if needed.

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