Co Insurance

The definition of Co Payment, and how it fits into the Zenefits Health Insurance Marketplace

What is a co-payment?

A copay, or copayment, is the amount paid out of pocket after a doctor’s visit or when paying for prescription medicine. Copays may vary from one plan to another, and emergency room visits may cost more than routine doctor’s visits.


How does a co-payment work?

Copays are commonly found as the benefit for more regular services, such as primary care doctor visits, specialist visits, and emergency coverage. Copays may also be used for In-Network services, but rarely for Out-of-Network services.

In most situations, the deductible does not need to be met before paying the copay (except if your plan is a High Deductible Health Plan). However, you should look at the plan Summary of Benefits and Coverage (SBC) to confirm that the deductible is waived for that service.