What is a health insurance doctor co-pay?

A doctor office co-pay is generally a fixed dollar amount paid by the insured for each office visit. Office visit co-payments do not apply to out of network providers in almost all health insurance policies.

The basics of health insurance
Doctor Office Copayment
Things to remember about office co-payments
Inclusive Co-Payment

Inclusive co-payments generally cover minor (non-surgical) procedures conducted during the office visit. Although diagnostic procedures such as MRI and CAT scans can be considered non-surgical, in most cases they are deductible and co-insurance. Some lab work such as blood test can be included as part of the co-payment, if billed separately the lab can charge its own co-payment. Always refer to your certificate of coverage for details.

Non-Inclusive Co-Payment

Non-inclusive co-payments only cover the cost of the visit itself. Procedures performed by the medical providers are billed as deductible and co-insurance in most cases. Always refer to your certificate of coverage for details.

Primary Care

Primary care doctor can be a family doctor, internal medicine or pediatrician.


Specialty care doctors are cardiologists, oncologists, neurologists and gastroenterologists to name a few.

Always check your provider network and certificate of coverage for your specific plan provisions.

Always consult your broker. Some rates, conditions and exclusions may apply. Information contained herein is to be used as an example only.