Piedmont Community Healthcare

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General Information

Plan Name:	Piedmont Community Healthcare
Service Area:	Lynchburg area
Brochure:	PDF Version
Brochure:	Text Version
NCQA Accreditation:	No
JCAHO Accreditation:	No
URAC Accreditation:	No
Plan Type:	POS
Enrollment Code-Self:	2C1
Enrollment Code-Self & Family:	2C2
Link to Plan Home Page:	http://www.pchp.net
Telephone:	888/674-3368

Benefits

In Network - Doctor Care/ Primary Office Visits:	30%
In Network - Hospital Inpatient Room and Board Charges:	None
In Network - RX/ Generic/ Retail:	$5
In Network - RX/ Brand/ Retail:	$15
In Network - RX/ Brand/ NonFormulary:	$15
Out of Network - Doctor Care/ Primary Office Visits:	30%
Out of Network - Hospital Inpatient Room and Board Charges:	None
Out of Network - RX/ Generic/ Retail:	$5
Out of Network - RX/ Brand/ Retail:	$15
Out of Network - RX/ Brand/ NonFormulary:	$15

Rates

Non-Postal
___Biweekly	Self: $36.73	Self: & Family: $84.78
___Monthly	Self: $79.58	Self: & Family: $183.69
___Twice Biweekly	Self: $73.46	Self: & Family: $169.56
_
Annuitants
___Monthly	Self: $79.58	Self: & Family: $183.69
_
U.S. Postal Service Employees (Type A)
___Monthly	Self: $41.32	Self: & Family: $96.29
___Biweekly	Self: $19.07	Self: & Family: $44.44
_
U.S. Postal Service Employees (Type B)
___Biweekly	Self: $25.36	Self: & Family: $73.05
___Monthly	Self: $54.94	Self: & Family: $158.28
_
Worker's Compensation Recipients
___Twice Biweekly	Self: $73.46	Self: & Family: $169.56
_
Certain Temporary Employees
___Biweekly	Self: $134.59	Self: & Family: $308.19
___Monthly	Self: $291.61	Self: & Family: $667.75
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Former Spouse Enrollees
___Monthly	Self: $291.61	Self: & Family: $667.75
___Biweekly	Self: $134.59	Self: & Family: $308.19
_
Temporary Continuation of Coverage
___Monthly	Self: $297.44	Self: & Family: $681.11
___Biweekly	Self: $137.28	Self: & Family: $314.35
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FDIC
___Biweekly	Self: $19.07	Self: & Family: $44.44
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