How COB works with prescription drugs Some of the limits and restrictions to prescription drug coverage listed in the “Limits on your prescription drug coverage” section will apply when UMP pays second to another plan. See the “Submitting a claim for prescription drugs” section for how to submit your prescription drug claim. Nonduplication of benefits applies when UMP pays second to another plan. This means that UMP may pay nothing after your primary plan pays. Using network pharmacies when UMP is secondary If you have primary coverage through another plan that covers prescription drugs, show both plan member ID cards to the pharmacy and make sure they know which plan pays first and which plan pays second. It is important that the pharmacy bills the plans in the correct order, or claims may be denied or paid incorrectly. Using mail-order pharmacies when UMP is secondary If your primary plan also uses one of UMP’s network mail-order pharmacies as the plan’s network mail- order pharmacy, UMP’s network mail-order pharmacies may process payments for both plans and charge you only the remainder. Make sure that UMP’s network mail-order pharmacies have the information for both plans and know which plan is primary. However, if your primary plan uses a different mail-order pharmacy, you will have to use your primary plan’s mail-order pharmacy, then submit a paper claim to UMP. See the “Submitting a claim for prescription drugs” section for how to do this. Billing and payment: submitting a claim Submitting a claim for medical services When UMP is your primary insurance and your provider is preferred, or participating, you do not need to submit claims. The provider will do it for you. If you have a question about whether your provider’s office has submitted a claim, sign in to your Regence account or contact UMP Customer Service (see Directory for link and contact information). See the “Submitting a Blue Cross Blue Shield Global® Core claim” section on page 24 for instructions on submitting a claim for services received outside of the United States. TIP: In the following section, Uniform Medical Plan (UMP) refers to the administrative functions for submitting claims to UMP. Regence BlueShield handles medical claims, and WSRxS handles prescription drugs claims. When you need to submit a claim You may need to submit a claim to UMP for payment if: • You receive services from an out-of-network provider. • You have other insurance that pays first and UMP is secondary. Out-of-network providers may submit a claim on your behalf. Ask your provider. 2024 UMP CDHP (PEBB) Certificate of Coverage 121