Inpatient ALERT! Your provider must notify the plan as soon as possible after you are admitted to a facility, but not later than 24 hours after you are admitted when you receive inpatient services. If the plan is not notified of inpatient treatment, the plan may not cover the treatment. Inpatient treatment is subject to clinical review. Services are considered inpatient when you are admitted to a facility. This may include either psychiatric inpatient hospitalization or care at a residential treatment facility. The plan must preauthorize non- emergency inpatient services. See the “Limits on plan coverage” section for details. Your provider must notify the plan as soon as possible after you are admitted to a facility, but no later than 24 hours after you are admitted to a: • Hospital • Residential treatment facility Contact UMP Customer Service about preauthorization requirements. Visit UMP Policies that affect your care webpage for a list of services that require plan notice. See Directory for link and contact information. Professional services (for example, doctors) may be billed separately from the facility charges. The plan pays the inpatient rate unless it is for emergency services. All covered professional services are paid based on the allowed amount. Outpatient ALERT! See page 40 for preauthorization requirements related to Applied Behavior Analysis (ABA) Therapy services. You pay the standard rate for outpatient mental health services. You pay based on the allowed amount and the network status of the provider. Most outpatient mental health services do not require preauthorization. Visit the UMP Policies that affect your care webpage for a list of services that require plan notice. Your provider must notify the plan as soon as possible, but not later than 24 hours after the following services are initiated: • Intensive Outpatient Therapy • Partial Hospitalization Program (PHP) Substance use disorder Substance use disorder is defined as an illness characterized by a physiological or psychological dependency on a controlled substance or alcohol. Substance use disorder does not include dependence on tobacco, caffeine, or food. To be covered, treatment programs must be licensed to provide treatment to persons requiring substance use disorder treatment. The amount the plan pays depends on the provider’s network status (see the “Finding a health care provider” section). See above for details about coverage for mental health services. Contact UMP Customer Service about preauthorization requirements. 42 2024 UMP CDHP (PEBB) Certificate of Coverage