Deliveries before 39 weeks gestation Vaginal or cesarean deliveries before 39 weeks of gestation are covered when the services are medically necessary. Examples include: • A medical emergency affecting the member or baby. • A medical condition of the member or baby for which a delivery is medically necessary. • Labor begins naturally (without medical intervention) before the member reaches 39 weeks of gestation. Vaginal or cesarean deliveries before 39 weeks of gestation are not covered when the services are: • Scheduled for convenience and not for medical necessity or medical emergency affecting the member or baby. • Neither the member nor baby have a medical condition for which immediate delivery is medically necessary. Talk to your provider about whether early delivery is for a medically necessary reason. For questions about this policy, contact UMP Customer Service. Services covered as preventive The following services are covered as preventive (not subject to your deductible or coinsurance when you see a preferred provider): • HIV counseling and testing. • Purchase of manual and electric breast pumps for pregnant and nursing members, plus supplies included with the initial purchase. Hospital-grade pumps are not covered. • Screening for diabetes during pregnancy. See “The UMP Preferred Drug List” section for prescription drugs that are preventive. They are listed as “Preventive” in the Tier column. Lactation (breastfeeding) counseling Lactation counseling is covered at the preventive rate during pregnancy and after birth to support breastfeeding when members receive services by a covered provider type. Note: Donor human milk from an approved milk bank for inpatient use may be covered when medically necessary. Ultrasounds during pregnancy The following limits do not apply to high-risk pregnancies. For example, a multiple pregnancy is considered high risk. Contact UMP Customer Service to learn what is covered for high-risk pregnancies. Routine ultrasounds during pregnancy are covered as follows: • One in week 13 or earlier • One during weeks 13-28 Adding a new dependent to your coverage For information about how to enroll new dependents in your health plan, refer to the Employee Enrollment Guide or the Retiree Enrollment Guide on the HCA website at hca.wa.gov/employee-retiree- benefits/forms-and-publications. You can also refer to “Making changes” in the “Eligibility and Enrollment” and in the “Eligibility and enrollment for a retiree or survivor” sections of this certificate of coverage for more information. 64 2024 UMP CDHP (PEBB) Certificate of Coverage