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Copayments, Groups and Plans

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 CBRACKFQ
CBRACKFQ
MAP BASICMAP 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 scaleNot 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 scaleNot 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 scaleNot 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 scaleNot 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