Co-Pays
Understanding your health coverage should be simple. Here, you will find clear information about the covered services and what your co-payments may be. You can feel confident about the care you receive and any costs along the way.
The chart below lists the services that are covered by WellKids by PA Health and Wellness when the services are medically necessary. Some of the services have limits or co-payments, need a referral from your PCP, or require prior authorization by WellKids by PA Health and Wellness. If you need services beyond the limits listed below, your provider can ask for an exception. If you have any questions, please call Member Services at 1-855-445-1920 (TTY 711).
SERVICE | Free | Low-Cost (Subsidized) | Full-Cost |
Doctors Office Visit |
|
|
|
Well-Child Primary Care Physician (PCP) | $0 | $0 | $0 |
Other Primacy Care Physician (PCP) Visit | $0 | $5 | $15 |
Specialist Visit | $0 | $10 | $25 |
Routine Gynecology Visit | $0 | $0 | $0 |
Other Gynecology Visit | $0 | $10 | $25 |
Obstetrical (maternity) visit | $0 | $0 | $0 |
Inpatient/Outpatient behavioral health visit for mental health or substance use care | $0 | $0 | $0 |
Outpatient occupational, physical, or speech therapy visit | $0 | $10 | $25 |
Emergency department (waived if admitted) | $0 | $25 | $50 |
Urgent care visits, including out-of-area urgent care | $0 | $10 | $25 |
Virtual Visits |
|
|
|
Primary Care Virtual Visit | $0 | $5 | $15 |
Specialty Virtual Visit | $0 | $5 | $25 |
Behavioral Health Virtual Visit | $0 | $0 | $0 |
Pharmacy - May Require Prior Authorization |
|
|
|
Generic drug | $0 | $6 | $10 |
Brand-Name Drug | $0 | $9 | $18 |
Preventive Drug | $0 | $0 | $0 |
Dental and Vision |
|
|
|
Routine Dental Services | $0 | $0 | $0 |
Routine Eye Exams | $0 | $0 | $0 |
If you have any questions or want to learn more about your child's co-pays, call Member Services at 1-855-445-1920 or TTY 711.