Mental Health and Substance Abuse
Treatment*
• Full coverage (not including room and board)
• $.50 to $3 copayment per service, limited to the first 15 hours or
$825 of services, whichever comes first, provided per calendar
year.
• Copayment not required when services provided in hospital
setting
Nursing Home Services
• Full coverage
• No copayment
Outpatient Hospital - Emergency Room
• Full coverage
• No copayment
Outpatient Hospital Services
• Full coverage
• $3 copayment per visit
Physical Therapy (PT), Occupational
Therapy (OT), and Speech Therapy (ST)
• Full coverage
• $.50 to $3 copayment per service
• Copayment obligation limited to the first 30 hours or $1,500,
whichever occurs first, during one calendar year (copayment
limits calculated separately for each discipline)
Physician Services
• Full coverage, including laboratory and radiology
• $.50 to $3 copayment per service limited to $30 per provider
per calendar year.
• No copayment for emergency services, anesthesia or
clozapine management
Prenatal /Maternity Care
• Full coverage, including prenatal care coordination, and
preventive mental health and substance abuse screening
and counseling for women at risk of mental health or
substance abuse problems
• No copayment
Reproductive Health Services
• Full coverage, excluding infertility treatments, surrogate parenting
and the reversal of voluntary sterilization
• No copayment for family planning services
Routine Vision
• Full coverage including coverage of eyeglasses
• $0.50 to $3 copayment per service
Smoking Cessation Services
• Coverage includes prescription and OTC tobacco cessation
products
• Refer to the drug benefit for information on copayments
Transportation – Ambulance, Specialized
Medical Vehicle (SMV), Common Carrier
• Full coverage of emergency and non-emergency transportation
to and from a certified provider for a BadgerCare Plus covered
service
-
$2 copayment for non-emergency ambulance trips
-
$1 copayment per trip for transportation by SMV
-
No copayment for transportation by common carrier or
emergency ambulance
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