TIP: You may use money from your HSA to pay for noncovered services if they are qualified medical expenses. Services not subject to your deductible The plan pays the allowed amount for the services listed below, subject to cost-share, even if you have not met your deductible. When you see a preferred or participating provider, you do not have to meet your deductible before the plan pays for these services: • Blood pressure monitor if you have a diagnosis of high blood pressure. • Certain medications covered through the prescription drug benefit as outlined on the UMP Preferred Drug List. • Continuous glucose monitors. • Covered contraceptive supplies and services for women. • Covered preventive care, including covered immunizations. • Diabetes Control Program. • Diabetes Prevention Program. • Glucometers. • Hemoglobin A1c testing, and retinopathy screening if you have a diagnosis of diabetes. • International Normalized Ratio (INR) testing if you have a diagnosis of liver disease and/or bleeding disorders. • Low-Density Lipoprotein (LDL) testing if you have a diagnosis of heart disease. • Peak flow meter if you have a diagnosis of asthma. • Second opinions required by the plan. • Tobacco cessation services. How your deductible works If you cover yourself only, your deductible is $1,600. You must pay this amount for covered services subject to the deductible (including covered prescription drugs) before the plan begins to pay for covered services. If you cover yourself and at least one other dependent, your deductible is $3,200. You and your dependent(s) combined must pay this amount for covered services subject to the deductible (including covered prescription drugs) before the plan begins to pay for covered services. You must pay this amount for covered services for all covered persons combined before the plan pays for any services, including prescription drugs (other than those not subject to the deductible). Once the deductible is met, the plan begins paying for covered services. Note: Only services that are covered and subject to the deductible count toward the deductible. See the “What does not count toward the deductible” page 25 for a list of services that do not count toward the deductible. 26 2024 UMP CDHP (PEBB) Certificate of Coverage