help a member recover from an acute covered illness, injury, or hospital stay. Home Health care is provided through visits from specialized clinicians, performing specific tasks (rather than time-based shifts), on a short-term basis, until specified individual goals are met. These services must be part of a treatment plan written by your provider (such as your physician or advanced registered practitioner [ARNP]). The provider must certify that you are homebound. These short-term visits may include: • Skilled nursing care, physical, occupational, or speech therapy • Home health aides and clinical social services, provided in conjunction with the skilled services of a registered nurse (RN), licensed practical nurse (LPN) or physical, occupational, or speech therapist • Disposable medical supplies as well as prescription drugs provided by the home health agency • Home infusion therapy • Home care of wounds resulting from injury or surgery • End-of-life counseling (see page 51) For services that may be covered under another benefit, such as nutritional counseling or follow-up care for bariatric surgery, see that benefit in this COC for coverage rules and limitations. These limitations apply even if the services are provided in the home or by a home health provider. For information on substitution of private duty nursing as an alternative benefit in lieu of hospitalization or in lieu of admission to a skilled nursing facility, see page 57 (hospital services) or page 69 (skilled nursing facility). Contact UMP Customer Service if you have questions. Hospice care Hospice (inpatient, outpatient, and respite care) is services provided by a state-licensed hospice program in the home or in a hospice facility to terminally ill patients. Services include pain relief care and support services that address the needs of terminally ill members and their families without intent to cure. Medical Hospice services received from preferred and participating providers are covered at 100 percent of the allowed amount after you meet your deductible. The plan covers hospice care for terminally ill members for no more than six months. See page 51 for coverage of end-of-life counseling. If you need hospice care, your provider will refer you to the program. For additional assistance, you may contact UMP Customer Service. Prescription drugs For covered prescription drugs, UMP members in hospice care receive special coverage when using network pharmacies, including the network specialty drug pharmacy and the network mail-order pharmacies. • Until your deductible is met, the member pays the full cost (allowed amount at a network pharmacy) for covered prescription drugs, except for covered insulins. There is no deductible for covered insulins. • After you pay your deductible, the plan pays for all covered prescription drugs purchased through a network pharmacy at 100 percent of the allowed amount for members in hospice care. This applies only to the member in hospice care. All quantity limits, preauthorization requirements, and coverage limits apply. 2024 UMP CDHP (PEBB) Certificate of Coverage 55