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Peoples Health Secure Choice #011Your Cost
Monthly Plan Premium$0
Inpatient Care
Inpatient Hospital CareThe amounts for each benefit period are $0* or:
– $1,364* deductible
– $0* per day for days 1-60
– $341* per day for days 61-90
– $682* per day for 60 lifetime reserve days
Inpatient Mental Health CareThe amounts for each benefit period are $0* or:
– $1,364* deductible
– $0* per day for days 1-60
– $341* per day for days 61-90
– $682* per day for 60 lifetime reserve days
Skilled Nursing Facility Care (Semiprivate Room and Board)For each benefit period you pay $0* or:
– $0* per day for days 1-20
– $170.50* per day for days 21-100
Labs and Tests
Advanced Imaging (MRI, MRA, CT, CTA, PET scans, etc.)$0 or 20% coinsurance*
Outpatient Care
Primary Care Physician Office Visit$0
Specialist Visit $0
Outpatient Mental Health or Substance Abuse Treatment Visit$0 or $10* for outpatient mental health visit
$0 or $40* for substance abuse visit
Outpatient Surgery (Outpatient Hospital Facility or Ambulatory Surgical Center)$0 or 15%* coinsurance
Emergency Ambulance Services$0 or 20%* coinsurance for each one-way trip
Emergency Care (within the U.S. and its territories)$0 or 20%* coinsurance (up to $75); waived if admitted to inpatient hospital care within three days for the same condition
Urgently Needed Care (within the U.S. and its territories)$0 or 20%* coinsurance (up to $65); waived if admitted to inpatient hospital care within three days for the same condition
Occupational, Physical or Speech Therapy Visit (Medicare limits apply)$0
Outpatient Medical Services and Supplies
Durable Medical Equipment (DME) (wheelchairs, oxygen, etc.)$0 or 20%* coinsurance
Home Health Care$0
Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider)$0 or 20%* coinsurance
Lab Services
$0 at a lab provider or outpatient hospital contracted to provide lab services to Peoples Health plan members; $0 or 20%* coinsurance at other locations
Diagnostic Tests and X-rays$0 or 20%* coinsurance
Preventive Care
Pap Smears, Pelvic Exams and Mammograms$0
Prostate and Colorectal Cancer Screenings$0
Bone Mass Measurement$0
Vaccinations (flu, pneumonia, hepatitis B)$0

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