Please note: Copayments do not apply to services provided at Indian Health Service facilities, services provided by schools or to Native American Medicaid clients.

SCHIP Copayment Schedule
Service Copayment Comments
Outpatient Physician Visit $5.00  
Urgent Care Visit $5.00  
Outpatient Therapy Visit $5.00  
Other Practitioner Visit $5.00  
Dental Office Visit $5.00 Does not apply if service is preventive, diagnostic or orthodontic
Emergency Room Visit $15.00 Does not apply if patient is admitted to the hospital
Inpatient Hospital Admission $25.00  
Pharmacy Prescription $2.00 Does not apply to medical supplies
Missed Appointment $5.00 If the patient does not contact the provider to cancel the appointment according to the provider's usual policy, the provider may charge the patient this copay.
Working Disabled Individuals (WDI) Copayment Schedule
Service Copayment Comments
Prescriptions $5.00 Includes covered prescription and non-prescription items.
Outpatient visit, other practitioner visit, clinic visit, urgent care visit, outpatient therapy sessions $7.00  
Dental Office Visit $7.00  
Emergency Room Visit $20.00  
Inpatient Hospital Admission $30.00