Emergency room TIP: If you need immediate care but your situation is not a medical emergency, see the “Urgent care” benefit for how to get treatment at a lower cost than in an emergency room. The plan covers facility charges for emergency room treatment when the treatment is for covered diagnoses and treatment of an injury. Covered services are paid at 85 percent of the allowed amount after you pay your deductible. Charges for professional services may be billed separately from facility (hospital or emergency room) charges. When you receive emergency services, you cannot be balance billed. If your emergency room visit is determined to be a medical emergency, it will be paid at the network rate for preferred, participating, and out-of-network facilities. Separate professional services charges will also be paid at the network rate if your emergency room visit is determined to be a medical emergency. End-of-life counseling End-of-life counseling involves discussing and planning for your end-of-life care, including treatment options and advanced directives. The plan covers end-of-life counseling for all members up to 30 visits per year. There is no requirement to be terminally ill, on hospice, or in the final stages of life to receive end-of-life counseling services. End-of-life counseling associated with hospice services is paid at 100 percent after you meet your deductible. Outside of hospice, these services are paid as a medical benefit, subject to your deductible and coinsurance. For more information on hospice care, see page 55. Family planning services If you receive care from a network provider, the plan will pay for the following covered services at 100 percent after you meet your deductible: • Contraceptive drugs and devices including condoms and spermicides • Voluntary and involuntary termination of pregnancy (abortion or miscarriage) • Education and counseling related to contraception If you receive care from an out-of-network provider, covered services are paid at the standard rate and the provider may balance bill you. If you go to a non-network pharmacy, you may have to pay at the time of purchase and submit a claim for reimbursement (see the "Submitting a claim for prescription drugs" section). You must get over-the-counter contraceptive supplies from a network pharmacy for these items to be covered (see “Over-the-counter contraceptives” in the next section below). Prescriptions purchased from an excluded pharmacy will not be covered. See the definition of “Excluded pharmacy.” Contraceptives ALERT! Visits for placement and removal of covered contraceptive devices that require professional insertion and removal are covered at the preventive rate. Contraceptives are covered under the prescription drug benefit. Contraceptives include, but are not limited to, birth control pills, emergency contraception (the “morning after” pill), vaginal rings, patches, 2024 UMP CDHP (PEBB) Certificate of Coverage 51