Copay Charts

Do you have to pay copays for a PCP, Specialist, ER visit, hospital stay, or other type of service? Not sure? Check the chart below, look at your ID card or call First Medical at 1-844-347-7800; TTY/TDD users should call 1-844-347-7805.


* Copays apply to diagnostic tests only.  Copays do not apply to tests required as part of a preventive service.

** Copays apply to each medicine included in the same prescription pad.