• Participating providers: You pay 40 percent of the allowed amount after you meet your deductible. The plan pays 60 percent of the allowed amount. • 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. Standard reference compendium Standard reference compendium refers to any of these sources: • The American Hospital Formulary Service Drug Information • The American Medical Association Drug Evaluation • The United States Pharmacopoeia Drug Information • Other authoritative compendia as identified from time to time by the U.S. Secretary of Health and Human Services State Agency State agency means an office, department, board, commission, institution, or other separate unit or division, however designated, of the Washington state government. It includes the legislature, executive branch, and agencies or courts within the judicial branch, as well as institutions of higher education and any unit of state government established by law. State-registered domestic partner State-registered domestic partner means an adult who meets the requirements for a valid state- registered domestic partnership and has been issued a certificate of state-registered domestic partnership by the Washington State Secretary of State, or an adult whose legal union (other than a marriage) was validly formed in another jurisdiction and is substantially equivalent to a domestic partnership under Washington law. Subscriber A subscriber is an eligible employee, retiree, former employee or former dependent in Continuation Coverage, retired employee of a former employer group, or survivor who is the primary certificate holder and plan member. Substance use disorder Substance use disorder is an illness characterized by a physiological or psychological dependency on a controlled substance or alcohol. Substance use disorder facility A substance use disorder facility is an institution, or part of an institution, that specifically treats dependency on a controlled substance or alcohol and meets all of these criteria: • Is certified by the Washington State Division of Behavioral Health and Recovery (DBHR), or for facilities outside of the Regence BlueShield service area, is contracted with the local BlueCard® network • Is licensed by the state • Keeps adequate patient records that contain course of treatment, progress, discharge summary, and follow-up programs 2024 UMP CDHP (PEBB) Certificate of Coverage 191