Active employees & non–Medicare-eligible retirees
A copayment is the cost you're required to pay for certain services or prescription drugs.
Your in-network copayments are:
Doctor's office visit: $15 per visit
Inpatient hospital care: $50 per admission (limited to one copayment per member per calendar-quarter)
Emergency room: $50 per visit (waived if admitted)
Mail-service prescription drugs: $20-$115
