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Employee health plan members: Copays to be required for more services at MIT Medical

December 7, 2010

Starting January 1, 2011, the $10 copayment that’s now required for medical specialty visits by patients enrolled in an MIT employee health plan will apply to most other visits as well. However, routine preventive visits will be exempt from the copayment requirement.

In January 2010, MIT Medical began charging copayments to patients enrolled in the MIT employee health plans for some visits to medical specialties. This was done to comply with the Mental Health Parity Act of 2008, a federal law that required health plans to cover the treatment of behavioral health disorders the same way they cover other medical benefits. When the federal government recently clarified that law, it became clear that copayments had to be the same for all medical services—not just specialty care, but primary care as well.

Preventive visits are excluded from this new requirement because the more recent federal health care reform law mandates that these types of visits must be provided at no additional cost to patients. Preventive visits include routine physicals, well-child visits and prenatal visits with providers in Primary Care, Pediatrics and Ob/Gyn, as well as immunizations and screening visits such as mammograms and colonoscopies. HealthCare.gov has a list of preventive services for which patients cannot be charged a copayment.

Here are some examples of MIT Medical visits by patients enrolled in the MIT Traditional or MIT Choice Plan and the copayment requirements.

Urgent Care $10 copay
Primary Care
Annual physical No copay
Visit for back pain $10 copay
Pediatrics
Baby’s six-month checkup No copay
Visit for a possible ear infection $10 copay
Ob/Gyn
Annual Pap smear No copay
Routine prenatal checkup No copay
Visit for pain or other possible problem $10 copay
Radiology, Audiology, Health Screening No copay

For security reasons, copayments must be made using Visa or MasterCard for Urgent Care visits in Cambridge and for all visits to MIT Medical/Lexington. For visits to other areas at MIT Medical/Cambridge, cash or check are also accepted. Patients who do not make the copayment at the time of their visit will be billed and may incur additional charges.

As before, copayments are not required for students for any visits to MIT Medical.

*This news story has not been updated since the date shown. Information contained in this story may be outdated. For current information about MIT Medical’s services, please see relevant areas of the MIT Medical website.

More information

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