Monthly Premiums and Co-Payments
Enrollees are responsible for monthly premiums and co-payments when services are received.
Premiums
The following premiums have been established to ensure that no individual premium is greater than $100.
Enrollee |
Monthly Premium |
Child (1-20) |
$25 |
Adult (21-54) |
$51.86 |
Adult (55-64) |
$99.85 |
The following co-payments will be the responsibility of each enrollee when services are received. The amount of the co-payment will depend on the enrollee's income.
Benefit |
Range of Co-payments |
Inpatient Acute Care Hospital |
$20 - $30 |
Emergency Room Services |
$20 - $25 |
Outpatient Diagnostics Services |
$15 |
Outpatient Surgery or Observation |
$20 - $25 |
| Primary Care Services | $5 - $10 |
| Specialty Physician Services | $15 - $20 |
| Prescription Drugs | $10 - $10 |