Yes, but members are required under their contract to pay the applicable cost sharing, which includes the Deductible, Copay, or Coinsurance as shown on the Schedule of Benefits. The requirement to pay the applicable cost sharing (Deductible, Copay, or Coinsurance) cannot be waived by a provider, a pharmacy or anyone under any “fee forgiveness,” “no out-of-pocket,” “discount program,” “coupon program” or similar arrangement. If a provider, pharmacy or third party (other than family) waives, discounts, reduces, or indirectly pays the required cost sharing (Deductible, Copays, Coinsurance) for a particular claim, the applicable cost sharing met by the member on the claim will be reduced to reflect the amount of such waiver, discount, reduction, or third party payment. The total amount accumulated toward any overall deductible and/or maximum out-of-pocket amounts will also be reduced by the amount of any discount.
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