What does "copay" refer to?

A copay refers to a predetermined fixed amount that a member must pay out-of-pocket when receiving specific healthcare services or products. This payment is typically mandated by an insurance plan and varies depending on the type of service received, such as a doctor's visit, specialist consultation, or prescription medication. The purpose of a copay is to share the cost of healthcare between the insurance provider and the insured individual, making healthcare services more accessible while also discouraging unnecessary use of medical services.

In this context, fixed amounts are established by insurance policy agreements and are essential for members to understand, as they influence budgeting for healthcare expenses. This concept is distinct from payments made directly to providers or insurance reimbursements, which do not involve a set fee from the member at the time of service.