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Discover How Copay First Works

Overview of Copay First

Copay First is an innovative plan from CDPHP. It features three distinct phases. Depending on how much you or your family utilize health care, you could remain in the 1st Copayment Phase for the entire plan year.

Please note that preventive services do not require a copay but do count toward the Copay First Accumulator.

* All member copays, coinsurances, and deductible expenses for covered services count toward the out-of-pocket maximum.

1st Copay Phase

  You’ll pay a copay for services.

 

  • You’ll pay a copayment for services received.*
  • CDPHP tracks the total allowed charge for each service.

1st Copayment Phase Example #1

  • Sally goes to the doctor for a sick visit and pays a $30 copay.
  • CDPHP pays $200 of the total allowed amount. 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 www.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 when she has reached 50% of her total allowed charges.*

1st Copayment Phase Example #2

  • Derek stays overnight in the hospital.
  • The total allowed charge for his services comes to $7,500.
  • Derek pays a $500 copay.
  • CDPHP pays $2,500, bringing his Copay First Accumulator to the $3,000 maximum allowance.

Deductible Phase

You’ll pay out of pocket for all services.

 

  • You’ll move into the deductible phase and pay the total allowed charge* for each service.
  • You’ll access this information online and with personalized reminders from CDPHP.

Deductible Phase Example #1

  • 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 is met.
  • CDPHP will send Sally Explanations of Benefits showing deductible amounts.

Deductible Phase Example #2

  • Derek now moves to the deductible phase and pays the remaining allowed charges of $4,500.
  • Derek goes to the pharmacy and pays the $40 allowed amount for his prescription.
  • Derek has now met $4,540 of his $6,000 deductible.

2nd Copay Phase

You’ll return to paying copayments.

 

  • Once the deductible is met, you’ll return to paying a copayment* for all services received until the out-of-pocket maximum is met.
  • Your Explanation of Benefits will denote that you’ve hit your out-of-pocket maximum, as will your online account information.

2nd Copay Phase Example #1

  • If Sally meets her medical plan deductible, she would move back to paying copays until she reaches the medical plan out-of-pocket maximum.

2nd Copay Phase Example #2

  • If Derek meets his medical plan deductible, he would move back to paying copays until he reaches his medical plan 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.