relating to non-surgical or surgical services are not covered. Such treatment is not covered even if prescribed by a provider, except as covered under "Bariatric surgery" (see page 41), “Diabetes Control Program” (see page 47), “Diabetes Prevention Program” (see page 47), “Nutrition counseling and therapy” (see page 62), or “Preventive care” (see page 65). ◦ Surgical: Any bariatric surgery procedure, any other surgery for obesity or morbid obesity, and any related medical services, drugs, or supplies, except when approved by preauthorization review. 132. Whole exome sequencing for: ◦ Uncomplicated autism spectrum disorder, developmental delay, mild to moderate global developmental delay. ◦ Other circumstances (e.g. environmental exposures, injury, infection) that reasonably explain the constellation of symptoms. ◦ Carrier testing for “at risk” relatives. ◦ Prenatal or pre-implantation testing. 133. Workers’ compensation: When a claim for workers’ compensation is accepted, all services related to that injury or illness are not covered, even if some services are denied by workers’ compensation 134. Transcranial Magnetic Stimulation (TMS) for treatment of: ◦ Obsessive-compulsive disorder (OCD) ◦ Generalized anxiety disorder (GAD) ◦ Posttraumatic stress disorder (PTSD) ◦ Smoking cessation ◦ Substance use disorder (SUD) If you have questions about whether a certain service or supply is covered, contact UMP Customer Service. If you have other HDHP coverage Coordination of benefits Coordination of benefits (COB) happens when you have health coverage through two or more groups (such as your employer and your spouse’s employer), and these two group health plans both pay a portion of your health care claims. The rules beginning under the “Who pays first” section determine which plan pays first (primary payer) and which pays second (secondary payer). See page 119 for a description of how the plan coordinates benefits when it pays second. The plan processes claims differently depending on if it is the primary payer or the secondary payer. The differences are described in the next several pages. TIP: If you have other health coverage, it is important that you let your providers know, including the pharmacies where you get your prescription drugs. 116 2024 UMP CDHP (PEBB) Certificate of Coverage