Efficacy Efficacy is the extent to which a specific intervention, procedure, service, supply, or prescription drug produces the desired effect under ideal conditions (in a controlled environment under lab circumstances). Elective contact lenses Elective contact lenses are covered lenses under the frame limit in lieu of coverage for eyeglasses. Emergency See the “Medical emergency” definition. Emergency fill Emergency fill is a process where the plan covers a limited amount of a prescription drug on an emergency basis while the plan processes your drug preauthorization request. Employer group Employer group for the Public Employees Benefits Board (PEBB) Program means those counties, municipalities, political subdivisions, the Washington health benefits exchange, tribal governments, and employee organizations representing state civil service employees obtaining employee benefits through a contractual agreement with the health care authority (HCA) to participate in benefit plans developed by the PEB board. Employer group for the School Employees Benefits Board (SEBB) Program means an employee organization representing school employees and a tribal school as defined in RCW 28A.715.010, obtaining employee benefits through a contractual agreement with the health care authority (HCA) to participate in benefit plans developed by the SEB board. Employing agency Employing agency means a division, department, or separate agency of state government, including an institution of higher education; a county, municipality, or other political subdivision; and a tribal government covered by chapter 41.05 RCW. Enrollee Enrollee means a person who meets all eligibility requirements and is enrolled in PEBB benefits, and for whom applicable premium payments have been made. Excluded pharmacy Excluded pharmacies are pharmacies or pharmacy chains that are prohibited from contracting with the Pharmacy Network, and that are not eligible to be reimbursed for Prescription Drug Claims. Prescriptions filled at excluded pharmacies are not covered. Locate a network pharmacy by visiting the UMP Prescription drug coverage webpage (see Directory for link). Experimental or investigational Experimental or investigational means any treatment that is not recognized by the plan as conforming to standard medical care for the condition, disease, illness, or injury being treated. ”Treatment” in this setting may include any intervention, therapy, procedure, facility, equipment, drug usage, device, service, 174 2024 UMP CDHP (PEBB) Certificate of Coverage