Discover How Copay First Works
Overview of Copay First
Copay First is an innovative plan from CDPHP®. It features two distinct phases. Depending on how much you or your family utilize health care, you could remain in the Copayment Phase for the entire plan year.
Please note there are no out-of-pocket costs for preventive services and those services do not count toward the Copayment Phase.
You’ll pay a copayment for all services received.*
CDPHP tracks the total allowed charge for each service.
Copayment Phase Example
➥ Sally goes to the doctor for a sick visit and pays a $30 copay.
➥ The total allowed charge of $230 is added to her Copay First Accumulator.
➥ Sally continues to go to the doctor as needed, paying a copay for each service.
➥ Sally logs into member.cdphp.com and is able to track the allowed charges for each service in the Copay First Accumulator.
➥ CDPHP will send Sally a benefit statement to notify her that she has reached 50% of her total allowed charges.*
Deductible Phase
You’ll move into the deductible phase and pay the total allowed charge* for each service until you meet your deductible/ out-of-pocket max.
After that, you’ll have no member cost share. You’ll access this information online and with personalized reminders from CDPHP.
Deductible Phase Example
➥ If Sally reaches the maximum allowance in her Copay First Accumulator she would move into the deductible phase of the plan.
➥ CDPHP will send Sally a letter to let her know she is now in the deductible phase of her medical plan.
➥ Sally is responsible for paying any allowed charges until her medical plan deductible/ out-of-pocket max is met.
➥ CDPHP will send Sally Explanations of Benefits (EOBs) showing deductible amounts.
* All member copays, coinsurances, and deductible expenses for covered services count toward the out-of-pocket-maximum.
Key Terms
Copay/copayment
What you’re responsible for paying for a medical service or prescription.
Allowed charge
The total of what you and CDPHP are paying for a service.
Copay First Accumulator
The total of allowed charges tracked for you during the first copay phase.
Deductible
The amount you pay out of pocket before your insurance will pay after you have exhausted your dollars in the Copay First Accumulator and moved to the Deductible Phase.
Out-of-pocket maximum
The absolute most you will pay out of pocket for your services in a plan year. Consult your Summary of Benefits and Coverage for details.
Copay First Plan Tools
Copay First Member Tip Sheet
CDPHP Price CheckTM
CDPHP Price Check creates cost transparency by giving you estimated costs on a range of health care services before you choose a doctor. Simply call the number on your member ID card and a CDPHP representative will provide a cost estimate based on the type of service and location.