Benefit/service How much you will pay For information, see page(s): Hospice care Special rate: 59, 176 • You pay $0 for medical services after meeting your medical deductible • You pay $0 for prescription drugs • You pay $0 for end-of-life counseling while in hospice after meeting your medical deductible Hospital services Inpatient rate 60, 64, 110 Outpatient/professional services: Standard rate Mammograms Diagnostic: Standard rate 62 Screening: Preventive rate Mental health See the “Behavioral health” benefit 44, 111, 112 Naturopathic If you see a naturopath for PCP services, you pay $0 63,103, 106 physician services For all other services: Standard rate Obstetric and Inpatient rate 64, 113 newborn care Outpatient/professional services: Standard rate Office visits PCP: You pay $0 for network PCP visits 66, 111 Specialty network provider: You pay 15% Prescription drugs No prescription drug deductible 88 See the “What you pay for prescription drugs” section Preventive care and Preventive care: Preventive rate 62, 65, 66, 89, 186 immunizations Covered preventive immunizations: Preventive rate Skilled nursing facility Inpatient rate 69, 110, 114, 189 Some services may be billed separately, such as physical therapy Spinal and extremity Special rate: 71 manipulations You pay a $15 copay per visit when you see a network provider. Substance use See the “Behavioral health” benefit 44 disorder Surgery Standard rate 60, 63, 66, 71, 75, 110, 114, 170, 182, 187 Therapy: Habilitative Inpatient rate 72 and Rehabilitative Outpatient/professional services: Standard rate Tobacco cessation Preventive rate 73 Vision care exam Preventive rate 79, 82 (routine) 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage 41