number of visits, these limits do not apply when the services, supplies, or interventions are for an autism diagnosis. Bariatric surgery TIP: Contact UMP Customer Service to locate a provider. For the plan to cover bariatric surgery, you must get preauthorization from the plan and follow all your chosen facility’s bariatric surgery requirements. This includes working with a multidisciplinary bariatric surgery team and ensuring your surgery and postsurgical treatment meet all plan medical policies. The plan covers only certain types of bariatric surgery procedures. If you meet the plan’s clinical criteria, non-Medicare adults age 18 or older will be eligible for covered bariatric procedures. Related care following bariatric surgery Panniculectomy (removal of loose skin) is covered following bariatric surgery when specific medical criteria are met. Most panniculectomies are considered cosmetic and are not covered. UMP will cover medically necessary surgical follow-up care related to a covered bariatric procedure, such as care for complications and needed revisions. The follow-up surgery must be appropriate and essential to the long-term success of the initial bariatric surgery and must be preauthorized. Members who had a bariatric procedure before coverage under a UMP plan and have complications or need medically necessary revision are not required to verify prior coverage or that they met the plan’s medical policy criteria for the initial bariatric procedure. However, you must follow plan requirements for follow-up care, including requesting preauthorization. Behavioral health The plan covers behavioral health services including care for mental health and substance use disorder. You pay the inpatient rate when admitted to an inpatient facility, and the standard rate for all other care and services. When you receive nonemergency services from an out-of-network provider at a network hospital, network hospital outpatient department, network critical access hospital, or network ambulatory surgical center, you pay the network rate and cannot be balance billed for services performed in Washington State or without your informed consent in states that allow you to waive the federal balance billing protections. When you receive emergency services you pay the network cost-sharing amount regardless of the network status of the provider or facility and cannot be balance billed. Mental health The plan covers mental health services for members with neuropsychiatric and mental health conditions. Marriage or family counseling is not covered. The amount the plan pays depends on the provider’s network status (see the “Finding a health care provider” section). See below for details about coverage for substance use disorder treatment. 2024 UMP CDHP (PEBB) Certificate of Coverage 41