A major feature of this plan is a tax-free Health Savings Account (HSA). You and your employer may contribute tax-free money into this savings account to pay for IRS-qualified medical expenses (such as the deductible and coinsurance), including certain services and certain drugs the plan may not cover. Contributions remain in your HSA until you use them; the balance rolls over from year-to-year. If you or your dependents are enrolled in UMP CDHP and want to enroll in another health plan, it must be another high-deductible health plan, but without an HSA. When enrolled in UMP CDHP, you may not also be enrolled in any of the following plans: • Medicare Part A or Part B. • Medicaid (called “Apple Health” in Washington). • Another comprehensive medical plan, such as a spouse or state-registered domestic partner’s plan. • A Voluntary Employees’ Beneficiary Association Medical Expense Plan (VEBA MEP) account, unless you convert it to a limited VEBA MEP. • TRICARE. • The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). • A medical flexible spending arrangement (FSA) or health reimbursement arrangement (HRA). This also applies if your spouse has a medical FSA, even if you are not covering your spouse on UMP CDHP. This does not apply to a Limited Purpose FSA. Accumulators Insurance accumulators may transfer when a subscriber changes their enrollment from one UMP plan to another UMP plan mid-year during a special open enrollment (SOE). When a subscriber enrolled in a PEBB Program UMP plan changes their own enrollment to another PEBB Program UMP plan (meaning the subscriber continues to be the subscriber on the new PEBB Program UMP Plan) during an SOE, the amounts already accrued toward medical and pharmacy deductibles, out- of-pocket limits, and benefit limits (see definition of “Limited benefit”) will transfer to the new PEBB Program UMP plan. These accumulators will also transfer for any member on the subscriber’s account who changes UMP plans with the subscriber. When a subscriber enrolled in a SEBB Program UMP plan changes their enrollment to a PEBB Program UMP plan (meaning the subscriber continues to be the subscriber on the new PEBB Program UMP Plan) during an SOE, the amounts already accrued toward the medical and pharmacy deductibles and the out- of-pocket limits for themselves and their enrolled dependents will transfer to the new PEBB Program UMP plan. These accumulators will also transfer for any member on the subscriber’s account who changes UMP plans with the subscriber. If you have questions, contact UMP Customer Service. Finding a health care provider As a UMP member, you may see preferred, participating, or out-of-network providers. The amount you pay for services depends on the network status of the provider. Seeing preferred providers will save you money. Visit the UMP provider search to find UMP CDHP providers. You can search for preferred or participating providers by signing in to your Regence account and selecting Find a Doctor. See the Directory pages at the beginning of this booklet for links and contact information. 2024 UMP CDHP (PEBB) Certificate of Coverage 15