Copay

After you meet your plan's deductible, you'll either pay for your care with copays or coinsurance. Many plans include a mix of both, where you pay copays for routine care (like doctor's visits and prescriptions), and coinsurance for more specialized services (like X-rays and surgery).

For medical plans, you pay nothing for in-network preventive care (including annual physicals, women's annual exams, vaccinations, and well-child checkups), regardless of your deductible.

A copay is when the cost for a service is fixed dollar amount. The amount depends on your insurance plan and the type of service you receive. For example, your copay for doctor’s office visits may be different than your copay for emergency room visits or mental health services. You may also have different copays for different types of prescription drugs.

To find out your copays, sign onto your Gusto account and follow these steps:

  1. Go to the Benefits tab.
  2. Click on the tile of the benefit you'd like to review.  
  3. If you have a copay, it will appear in the "What’s Covered" section. 
  4. Your copay will also appear on your Summary of Benefits and Coverage, which you can download by clicking Download full details (PDF).
    • If you need more info check out our guide to your SBC. To verify covered services, call your insurance carrier directly.

Note: This article is relevant to companies who have benefits brokered by Gusto. For companies with benefits managed by another broker, contact your broker of record for your plan details.