Updated December 05, 2016-- For Administrators and Employees

$30 copay/$45 copay (after pharmacy deductible) Not covered: $35 copay/$50 copay (after pharmacy deductible) Contraceptives; No charge. OTHER: Dental services $30.

1. $30 Copay: Specialist Visit: $60 Copay: Laboratory Outpatient and Professional Services: 30.00% Coinsurance after deductible: X-rays and Diagnostic Imaging: 30.00% Coinsurance after deductible: Diagnostic Imaging such as MRIs, CT, and PET scans: 30.00% Coinsurance after deductible: Deductible - Family: $2700 per group: Out-of-Pocket Maximum.
2. $30 copay You pay 40% after deductible $70 copay You pay 40% after deductible $0 per consultation Immediate Care Urgent Care $50 copay You pay 20% after deductible You pay 40% after deductible $50 copay Emergency Care You pay 30% after deductible You.

Copays for High Deductible Health Plans (HDHPs) work a little different from other types of plans. Typically with HDHPs, employees must meet their deductible before the carrier will pay for any services other than preventative care.

This means that if you have an HDHP with a $3,000 deductible and a $20 copay for primary care, you may have to meet the entire deductible before the copay will apply. This is why HDHPs are often paired with HSAs - the pretax contributions help offset the $3,000 deductible amount that you'll pay out-of-pocket before your copay can apply.

Note:

$50 Copay After Deductible

1) Plan payments for covered health services are based on usual and customary charges.
2) Should there be a conflict between this summary and the Plan Document, the Plan Document will be the final authority.

* Custodial care is not a covered health service
** Shingles vaccination is covered under Medical and Prescription Drug plans
*** No need to coordinate with Medicare

Although Con Edison currently sponsors the Retiree Health Program, the information above does not alter the company’s right to change or terminate the program at any time due to changes in laws governing employee benefit plans, the requirements of the Internal Revenue Code, Employee Retirement Income Security Act, or for any other reason. The company is not obligated to contribute any fixed amount or percentage of program costs.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that requires Con Edison and the health plans sponsored by the company to protect your personal health information (PHI). As a participant under one of the health plans offered by Con Edison, we are required to notify you of the privacy practices that will be followed by the company and the plans and your rights concerning your personal health information.

Under the law and privacy practices, we have the responsibility to protect the privacy of your personal health information by:

What Is Copayment With Deductible

$30 Copay 30 Coinsurance After Deductible

1. limiting who may see it
2. limiting how we may use or disclose it
3. explaining our legal duties and privacy practices
4. adhering to these privacy practices
5. informing you of your legal rights