Benefit/service How much you will pay For information, see page(s): Hospice care Special rate: 53, 181 • 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 55, 61, 112 Outpatient/professional services: Standard rate Mammograms Diagnostic: Standard rate 60 Screening: Preventive rate Mental health See the “Behavioral health” benefit 39, 113, 115 Naturopathic Standard rate 18, 61, 105, 110 physician services Obstetric and Inpatient rate 61, 115 newborn care Outpatient/professional services: Standard rate Office visits Standard rate 63, 114 Prescription drugs See the “What you pay for prescription drugs” 88 section Preventive care and Preventive care services: Preventive rate 60, 63, 64, 90, 190 immunizations Covered preventive immunizations: Preventive rate Skilled nursing facility Inpatient rate 67, 112, 116, 194 Some services may be billed separately, such as physical therapy Spinal and extremity Special rate: 68 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 55, 56, 61, 64, 69, 69, 72, 75, 112, 117, 173, 186, 192 Therapy: Habilitative Inpatient rate 72 and Rehabilitative Outpatient/professional services: Standard rate Tobacco cessation Preventive rate 74 Vision care exam Preventive rate 80, 83 (routine) 36 2024 UMP Select (PEBB) Certificate of Coverage