Copays are your out-of-pocket expenses for certain benefits, usually at the time of an appointment. In general, doctor’s appointments cost $15 and prescriptions cost $7. The maximum amount of copays per benefit year is $640. After that, you don’t
need to pay any more copays for the rest of the benefit year. Keep track of your copays so you will know when you have reached this limit.
See the ACE Copays List for more information
Annual Participation Fee
ACE Participants must pay a $360 non-refundable annual Participation Fee in order to receive services. With copays, the most you will pay in out-of-pocket expenses per benefit year is $1,000.
You can either pay the full amount up front at once or in monthly payments
- If you pay the full $360 up front, you will receive $45 in San Mateo County ACE Bucks that you can use toward copays
- Otherwise, HPSM will send you a monthly invoice until your annual Participation Fee is paid off
There are two ways you can pay your annual Participation Fee:
1) Mail a check or money order to:
Health Plan of San Mateo
c/o ACE Program Annual Participation Fee
801 Gateway Blvd., Suite 100
South San Francisco, CA 94080
2) Bring a check, money order or cash to HPSM during office hours: Monday through Friday from 8:00 a.m. to 5:00 p.m.
- If you pay by cash, you must have the exact amount
- HPSM does not accept credit or debit cards
Fee Waiver and Assistance
ACE Participants who qualify for the Fee Waiver do not have to pay copays or the annual Participation Fee. If you qualify, your ACE Participant Identification Card will show “$0” under copay. If you are receiving monthly invoices but think
you qualify for the Fee Waiver, call the Health Coverage Unit at 650-616-2002.
You can also request Fee Assistance to reduce the amount of your ACE Participation Fee. You can get a form from a Community Health Advocate at your Primary Care Provider clinic location or from your community application assistor. You may also contact the Health Coverage Unit at 650-616-2002. If you are approved for Fee Assistance, you will still be responsible for copays.
If you have questions about the Participation Fee, call HPSM’s Member Services department at 1-800-750-4776 or 650-616-2133.