Copayments, Groups and Plans
| CBRACKFQ CBRACKFQ | MAP BASIC | MAP Dental CHAP |
|
|---|---|---|---|
| Primary Care Office Visit | $10 copay or $0 copay if noted on MAP card | BASIC 000: $0 co-pay BASIC 100: $10 copay BASIC 150: $15 copay BASIC 175: $25 copay BASIC 200: $30 copay | Not A CHAP Benefit |
| Specialty Care Office Visit | $10 copay or $0 copay if noted on MAP card | Not a MAP BASIC benefit. Services subject to healthcare provider sliding fee scale or charity copay scale | Not A CHAP Benefit |
| Urgent Care | $10 copay or $0 copay if noted on MAP card | Not a MAP BASIC benefit. Services subject to healthcare provider sliding fee scale or charity copay scale | Not A CHAP Benefit |
| In-Patient | $30 copay or $0 copay if noted on MAP card | Not a MAP BASIC benefit. Services subject to healthcare provider sliding fee scale or charity copay scale | Not A CHAP Benefit |
| Emergency Room | $25 co-pay or $0 co-pay if noted on MAP card | Not a MAP BASIC benefit. Services subject to healthcare provider sliding fee scale or charity copay scale | Not A CHAP Benefit |
| Dental Office Visit | $10 co-pay or $0 co-pay if noted on MAP card $35 per partial or $0 co-pay if noted on MAP card $50 per plate or $0 co-pay if noted on MAP card | Not a MAP BASIC benefit. Services subject to healthcare provider sliding fee scale or charity copay scale | $10 co-pay or $0 co-pay if noted on MAP card $35 per partial or $0 co-pay if noted on MAP card $50 per plate or $0 co-pay if noted on MAP card |
| Pharmacy Formulary Non-Formulary | https://centralhealth.sbdev.io/medical-access-program-provider/pharmacy-copayments/ | https://centralhealth.sbdev.io/medical-access-program-provider/pharmacy-copayments/ | Not A CHAP Benefit |