Benefit/service How much you will pay For information, see page(s): Hearing aids Special rate: 53, 130 • No medical deductible • You pay $0 of the $3,000 benefit limit per ear every 3 years Home health care Standard rate 54, 114, 189, 191 Hospice care Special rate: 54, 190 • You pay $0 for medical services after meeting your medical deductible • You pay $0 for prescription drugs after meeting your prescription drug deductible • You pay $0 for end-of-life counseling while in hospice after meeting your medical deductible Hospital services Inpatient rate 56, 62, 115 Outpatient/professional services: Standard rate Mammograms Diagnostic: Standard rate 61 Screening: Preventive rate Mental health See the “Behavioral health” benefit 39, 116, 117 Naturopathic Standard rate 18, 62, 107, 112 physician services Obstetric and Inpatient rate 62, 117 newborn care Outpatient/professional services: Standard rate Office visits Standard rate 64, 116 Prescription drugs See the “What you pay for prescription drugs” 90 section Preventive care and Preventive care services: Preventive rate 61, 64, 65, 91, 199 immunizations Covered preventive immunizations: Preventive rate Skilled nursing facility Inpatient rate 68, 114, 118, 203 Some services may be billed separately, such as physical therapy Spinal and extremity Special rate: 70 manipulations You pay a $15 copay per visit when you see a preferred provider. Substance use See the “Behavioral health” benefit 39 disorder Surgery Standard rate 56, 57, 62, 65, 70, 70, 73, 77, 114, 119, 182, 195, 201 Therapy: Habilitative Inpatient rate 74 and Rehabilitative Outpatient/professional services: Standard rate Tobacco cessation Preventive rate 75 36 2024 UMP Classic (PEBB) Certificate of Coverage