Copay Discounting

Corporate Procedure

Policy Name

Copay Discounting

Policy Number


Policy Manual Section


Related Policies


Issuing Department

Provider Network Management

Approving Authority


Original Policy Date


Revision Date(s)


Review Date(s)
(No revisions)


Replaces Policy Number


I.    Policy Purpose and Statement of Intent

  • “HealthPlus” shall refer to HealthPlus of Michigan, Inc. and its affiliated entities, HealthPlus Partners, Inc., HealthPlus Options, Inc., and HealthPlus Insurance Company, unless otherwise stated.
  • The procedure shall pertain to the Commercial, TPA, PPO, Medicaid, MIChild, County Health Plan, Medicare, and Medicare Part D product lines.
  • To assure that the organization complies with all applicable State and Federal laws and regulations, including, but not limited to, those pertaining to the Medicaid, Medicare, and Medicare Part D programs.
  • To define the process used to contract with Providers, terminate Providers, and provide appeal rights to Physicians when terminated for non-quality reasons.
  • It is HealthPlus of Michigan’s Policy to disallow the discounting of co-payment benefits.

II.   Procedure Statement

  1. A provider will look at HealthPlus Enrollees for payment of applicable co-payments at the amount determined by the subscriber’s benefit level.

A provider promoting or applying co-payment discounts will be subject to the following sanctions:

  1. 1st Offense – written warning to cease such activity
  2. 2nd Offense – certified letter warning provider of termination if activity continues.
  3. 3rd Offense – certified letter notifying provider of termination of provider status.


A provider who desires to appeal any level of the sanction process can do so in writing to the HPM Medical Affairs Committee (MAC) within 30 days after receipt of sanction notification by HealthPlus.

The MAC will adjudicate appeals and notify the provider of its decision.

III.  Implementation

Administrative staff is responsible for establishing, publishing, and maintaining procedures and work rules to implement this procedure. 

Additional Resources: