StacksVerified U.S. regulatory reference

42 CFR §457.515

Verified against eCFR.gov as of June 20, 2026View official text on eCFR.gov ↗
To impose copayments, coinsurance, deductibles or similar charges on enrollees, the State plan must describe—
  1. (a)The service for which the charge is imposed;
  2. (b)The amount of the charge;
  3. (c)The group or groups of enrollees that may be subject to the cost-sharing charge;
  4. (d)The consequences for an enrollee who does not pay a charge, and the disenrollment protections adopted by the State in accordance with § 457.570;
  5. (e)The methodology used to ensure that total cost-sharing liability for a family does not exceed the cumulative cost-sharing maximum specified in § 457.560; and
  6. (f)An assurance that enrollees will not be held liable for cost-sharing amounts for emergency services that are provided at a facility that does not participate in the enrollee's managed care network beyond the copayment amounts specified in the State plan for emergency services as defined in § 457.10.