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The Tonik Health Plan Copay and You

Aug 24, 2008
Let's take a look at the office copay for Tonik health insurance plans. Tonik was designed to give people access to coverage for the things they use most and keep cost down. The office copay definitely fits in this category. First, what does the term copay mean.

First, what is a copay? Officially, a copay is the fixed portion of charges you pay to your provider for covered health care services in addition or separate from any deductible. For example, $20 for an office visit or $15 for a prescription drug. It is similar to coinsurance, but it is a dollar amount instead of a percentage of the charges.

The whole point of a copay is to give you a cost for certain health care services that you can count on. No hidden surprises. If an in-network doctor charges $65 and a specialist charges $95, you can the same flat copay amount and this takes some of the guesswork (and fear) out of going to a doctor when you need care. There are a few qualifications on the Tonik health plan office copays we should look at.

More detail on the Tonik office copays

The copay typically applies to the office consultation itself. It's not uncommon for other services such as labs or simple procedures to be done during an office visit. These servcies outside the consultation would usually go towards your Tonik plan's deductible. For example, let's say you feel pretty lousy and go to your general practice doctor. The copay would apply for this visit. If the doctor decides to run a blood test to make sure it's not a serious issue. You would pay the discounted rate (assuming in-network providers/ covered benefits) for this labwork subject to your deductible. Speaking to the "benefits need and keep cost low", some Tonik insurance plans cap the number of office visit copays you have in a calendar year. After using these visits, additional visits in the same calendar year would be subject to the deductible. This number was based on what the average member needs in a typical year based on the theory that most people will find this perfectly adequate and the premium can be kept lower.

Tonik deductible and network providers

It's important to stay within Tonik's doctor network to get full benefit of the office copays. You will likely pay more out of pocket when using a non-network provider. Luckfully, the PPO network is pretty extensive but it's always important to verify with your doctor of choice that they are in the Tonik PPO network.

Prescription Copays in Tonik

There is also a separate copay for generic only medications. Brand name medications are not covered with the typical Tonik health insurance plan even if there is not generic available as an alternative. The generic copay usually runs $10 and is for a $30 day supply. There is also an option of $20 copays for 60 day supplies when purchased through mail order.
About the Author
Dennis Jarvis is a licensed California broker with extensive knowledge of Tonik health insurance plans.
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