Screening Screening refers to services performed to prevent or detect illness in the absence of disease or symptoms. Secondary coverage When you are covered by more than one group health plan, you have secondary coverage that may pay a part or the rest of a provider’s bill after your primary payer has paid. See the “If you have other HDHP coverage” section for more information on how this plan coordinates benefits. Skilled nursing care Skilled nursing care is services from licensed nurses in your own home or in a nursing home. Skilled care services are from technicians and therapists in your own home or in a nursing home. Skilled nursing facility A skilled nursing facility is an institution, or part of an institution, that provides skilled nursing care 24 hours a day and is classified as a skilled nursing facility by Medicare. Medicaid-eligible, long-term care facilities are not necessarily skilled nursing facilities. SmartHealth SmartHealth is a voluntary wellness program offered by the PEBB Program that allows eligible subscribers to earn wellness incentives. Employees who waive medical and eligible retirees who defer PEBB retiree insurance coverage are not eligible to qualify for the incentive. The wellness incentive that you qualify for during the 2023 plan year is deposited into your HSA in January 2024 if you are still eligible to participate in the wellness incentive program. The wellness incentive that you qualify for during the 2024 plan year is deposited into your HSA in January 2025 if you are still eligible to participate in the wellness incentive program and are enrolled in the 2025 plan year. The wellness incentive applies to your maximum annual contribution limit. More details on eligibility and program requirements are on HCA's SmartHealth webpage at hca.wa.gov/pebb-smarthealth. Special rate The plan’s special rate is for services that have unique payment rules. These rules are described in the table (see the “How much you pay for covered services” column) located in the “Types of services” section. Specialty drugs Specialty drugs are high-cost injectable, infused, oral, or inhaled prescription drugs or products that require special storage or handling and are subject to additional rules. Specialty drugs are identified on the UMP Preferred Drug List. See page 99 for information on how specialty drug prescriptions are handled. Standard rate The plan’s standard rate depends on the provider’s status: • Preferred providers: You pay 15 percent of the allowed amount after you meet your deductible. The plan pays 85 percent of the allowed amount. 190 2024 UMP CDHP (PEBB) Certificate of Coverage