• When you have received a recovery from another source relating to an illness or injury for services for which we normally would provide benefits. The amount of any exclusions under this provision, however, will not exceed the amount of your recovery. • Until the total amount excluded equals the third-party recovery. General provisions UMP is administered by Regence BlueShield and Washington State Rx Services under contract with HCA. What you need to know: your rights and responsibilities To make sure UMP offers access to the best possible medical care, we must work together with you and your providers as partners. To achieve this goal, you must know your rights and responsibilities. As a plan member, you have the right to: • Ask your provider to submit secondary claims to Medicare, if applicable. • Be informed by your providers about all appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage. • Be treated with respect. • Complain about or appeal plan services or decisions, or the care you receive. • Get a second opinion about your provider’s care recommendations. • Have a translator’s assistance, if required, when contacting the plan. • Keep your medical records and personal information confidential as described in the UMP Notice of Privacy Practices, available online on the HCA website at hca.wa.gov/ump-privacy. • Make decisions with your providers about your health care. • Make recommendations about member rights and responsibilities. • On request, receive information from the plan about: ▪ How new technology is evaluated for inclusion as a covered service. ▪ How the plan reimburses providers. ▪ Preauthorization review requirements. ▪ Providers you select and their qualifications. ▪ Services and treatments that have completed HTCC review and how that affects coverage by UMP. ▪ Technologies and treatments currently under review by the HTCC. ▪ The plan and preferred providers. ▪ Your covered expenses, exclusions, reductions, and maximums or limits. • Receive: ▪ A written explanation from the plan about any request to refund an overpayment. ▪ All covered services and supplies determined to be medically necessary as described in this COC, subject to the maximums, limits, exclusions, deductible, and coinsurance. ▪ Courteous, prompt answers from the plan. 2024 UMP CDHP (PEBB) Certificate of Coverage 133