Non-network pharmacy A non-network pharmacy does not contract with WSRxS. See page 96 for what happens if you use a non-network pharmacy to purchase covered prescription drugs. Non-network pharmacies do not include excluded pharmacies (see the definition of “Excluded pharmacy”). Nonprescription alternative A nonprescription alternative includes an over-the-counter drug, dietary supplement, herbal supplement, vitamin, mineral, medical food, or medical device that you may buy without a prescription that has similar safety, efficacy, and ingredients as a prescription drug. Nonprescription drug A nonprescription drug includes an over-the-counter drug, dietary supplement, herbal supplement, vitamin, mineral, medical food, or medical device that you may buy without a prescription. Normal benefit The plan’s normal benefit is the dollar amount the plan would normally pay if no other group health plan had the primary responsibility to pay the claim for a benefit. Occupational injury or illness An occupational injury or illness is one resulting from work that is for pay or profit. Orthognathic and Telegnathic surgery Orthognathic surgery is surgery to correct conditions of the jaw and face related to structure, growth, or TMJ disorders, or to correct orthodontic problems that cannot be easily treated with braces. Telegnathic surgery means skeletal advancement to enlarge and stabilize the pharyngeal airway to treat obstructive sleep apnea. Out-of-network provider(s) An out-of-network provider is a health care provider that is: • In the Regence BlueShield service area, but is not contracted as part of Regence BlueShield’s PPO network; or • Outside the Regence BlueShield service area but is not contracted with another Blue Cross or Blue Shield organization in the BlueCard® Program (designated as a provider in the PPO network) to provide services and supplies to plan members. See page 17 for a description of how services by these providers are covered. Out-of-network provider(s), vision Out-of-network provider(s), vision do not have a contract with VSP. Out-of-network rate Out-of-network providers are paid at the out-of-network rate. When you receive medical services from out-of-network providers, you pay 40 percent of the allowed amount after you meet your deductible. You pay all charges billed to you above the allowed amount (known as balance billing). The plan pays 60 percent of the allowed amount. 2024 UMP CDHP (PEBB) Certificate of Coverage 183