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Co-Payment Information

WellCare of Nebraska Members Have No Co-Pays for Covered Health Care Services.

Members may have to pay a small fee when they get some health care services. This fee is called a "co-payment" or "co-pay" for short. The following individuals do not have co-pays:

  • Members age 18 or younger; pregnant women through the immediate postpartum period (this period last for 60 days after delivery and continues through the end of the month in which the 60th day occurs)
  • Pregnant members, during pregnancy and through postpartum – the last day of the month following the 60-day postpartum period
  • Any member who is an inpatient in a hospital, long-term care facility (nursing facility or ICF/MR), or other medical institution who is required to spend all but a minimal amount of his/her income for medical care costs
  • Members who live in alternate care, which is defined as domiciliaries, residential care facilities, centers for the developmentally disabled and adult family homes
  • Native American who receive items and/or services furnished directly by a Native American Health Care Provider or through referral from a Native American Health Care Provider under contract health services
  • Individuals who are receiving waiver services provided under s 1915(c) waiver, such as the Community-Based Waiver for Adults with Intellectual Disabilities or Related Conditions; The Home and Community-Based Model Waiver for Children with Intellectual Disabilities and their Families; or the Home and Community-Based Waiver for Aged Persons or Adults or Children with Disabilities or the Early Intervention Waiver
  • Individuals who receive assistance under the State Disability Program (SDP)

What Services Are Covered?

Here are a couple of important things to remember when getting your care:

  • WellCare of Nebraska or an in-network provider must approve your care
  • If you get a service that we do not approve, you may have to pay for it yourself
  • Sometimes we may not have a provider in our network who can give you needed care; if this happens, we’ll cover the care out-of-network (at no additional cost to you), but you will need to get approval first from us
  • WellCare of Nebraska members may receive family-planning services and related supplies from appropriate Medicaid providers outside our network without any restrictions; the out-of-network provider must bill WellCare of Nebraska and be reimbursed at no less than the Medicaid rate in effect on the date of service
  • With approval, we will ensure that the cost to you is no greater than it would be if the services were performed within our network. Please see the Understanding Referrals and Prior Authorizations section for more information

WellCare of Nebraska Plan Documents

Your Member Handbook explains your plan coverage in detail. It includes important information about your benefits, your rights, and key contact addresses and phone numbers.

This document includes all of your covered services and their co-pay amounts.

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Last Updated On: 8/13/2018