Lewiston, ID 83501-1106 If you have questions about the network waiver process, contact UMP Customer Service. ALERT! If a network waiver is approved, you must still pay your cost-share for most medical services. Services provided under an approved network waiver apply to your deductible and out-of-pocket limit. Network waivers for ongoing services may require periodic review. How an HSA works ALERT! If you enroll in a consumer-directed health plan with an HSA, you can also choose to enroll in a Limited Purpose Flexible Spending Arrangement (FSA). Limited Purpose FSA funds can be used only for dental and vision expenses, which allows you to save your HSA funds for medical expenses. A Limited Purpose FSA is different from a Medical FSA. You may not have a Medical FSA and an HSA in the same year, as you may be subject to tax penalties. The subscriber is the owner of the HSA. They get the tax advantages associated with an HSA and pay any taxes or penalties that result if the HSA does not comply with Internal Revenue Service (IRS) rules. The subscriber may contribute funds to the HSA within certain limits. Money from the HSA may be used to pay for qualified medical expenses of the subscriber, spouse or tax dependents (claimed as a tax dependent), even if they are not enrolled in this plan. See page 27 for details of how this works with UMP CDHP. The trustee (manager) of your HSA, HealthEquity, features a member portal on their website (see Directory for link). When you sign into your Regence account, you may also find a link to the HealthEquity portal. Find out which services are available in the portal by reading the “Online services” section. ALERT! You and your dependents may only enroll in other high-deductible health plans that do not include an HSA. Out-of-area services Regence BlueShield has a variety of relationships with other Blue Cross and/or Blue Shield Licensees. Generally, these relationships are called “Inter-Plan Arrangements.” These Inter-Plan Arrangements work based on rules and procedures issued by the Blue Cross Blue Shield Association. Whenever you access health care services outside of the geographic area Regence BlueShield services, the claim for those services may be processed through one of these Inter-Plan Arrangements. The Inter-Plan Arrangements are described below. When you receive care outside of Regence BlueShield’s service Area, you may receive it from Providers as described below. Providers contracted with the local Blue Cross and/or Blue Shield Licensee in that geographic area ("Host Blue") as a preferred provider are paid at the preferred provider level and will not bill you for balances beyond any deductible, copayment and/or coinsurance for covered services. Providers that contract with the Host Blue as a participating provider are paid at the participating provider level and will not bill you for balances beyond any deductible, copayment and/or coinsurance for covered 2024 UMP CDHP (PEBB) Certificate of Coverage 21