Covered and noncovered provider types Covered provider types The plan pays the allowed amount for covered services only when performed by covered provider types within the scope of their license(s). When a facility charges facility fees, the plan pays the allowed amount if the services are covered services and are within the scope of the facility’s license. All preferred and participating providers are covered provider types. See the list of covered provider types at the UMP website at ump.regence.com/pebb/benefits/providers/covered-providers. Noncovered provider types If you see a provider who is not a covered provider type, such as a Licensed Athletic Trainer, the plan will not pay for any of the services received, and you will pay for all charges. As with all noncovered services, any payments you make to a noncovered provider type will not apply to your deductible or out-of-pocket limit. If you have questions about noncovered providers contact UMP Customer Service. Primary care providers A primary care provider (PCP) is a physician, nurse practitioner, or physician assistant who provides, coordinates, and helps you access a range of health care services, such as covered immunizations. A PCP may also help coordinate care for you when you need to see specialists. You are not required to choose a PCP. However, a PCP may help prevent and treat health care conditions early, promoting your health and well-being. Patients who have a PCP have better health outcomes and a better care experience. To be designated as a PCP, a provider must be one of the provider types and practice under one of the specialties listed below. Provider type: • Doctor of Osteopathic Medicine (D.O.) • Nurse Practitioner (A.R.N.P.) • Medical Doctor (M.D.) • Physician Assistant (P.A.) • Naturopathic Physician (N.D.) Specialties: • Adult Medicine • Internal Medicine • Family Practice • Obstetrics and gynecology (OB/GYN) • General Practice • Pediatrics (for members under age 18) • Geriatrics • Preventive Medicine When you do not have access to a preferred provider: network waiver An approved network waiver allows the plan to pay for covered services provided by an out-of-network provider at the network rate. You may request a network waiver only when you do not have access to a preferred provider able to provide covered medically necessary services within 30 miles of your residence. A service or supply prescribed, ordered, recommended, approved, or given by a provider does not make it a medically necessary covered service or supply. 2024 UMP CDHP (PEBB) Certificate of Coverage 19